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Khawaja AA, Whitlock G, Fidler S, Soler-Carracedo A, Henderson M, Taylor GP, Boffito M, Emerson M. Evaluation of the effect of 48 weeks of BIC/F/TAF and DRV/c/F/TAF on platelet function in the context of rapid ART start. HIV Res Clin Pract 2025; 26:2447015. [PMID: 39763430 DOI: 10.1080/25787489.2024.2447015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 12/19/2024] [Accepted: 12/19/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION The BIC-T&T study aimed to determine the efficacy of bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) and darunavir/cobicistat/emtricitabine/tenofovir alafenamide (DRV/c/F/TAF) at suppressing viral load in a two-arm, open-label, multi-centre, randomised trial under a UK test-and-treat setting. This sub-study aimed to evaluate potential off-target cardiovascular impact by examining ex vivo platelet function. METHODS Platelets were isolated by centrifugation of citrated blood from participants attending Chelsea and Westminster Hospital or St Mary's Hospital at Week 48 following enrolment. Platelet activation was assessed by real-time flow cytometry to examine integrin activation and granule release and platelet aggregation was evaluated by light transmission aggregometry. Statistical significance was determined by 2-way ANOVA with a Šidák's multiple comparisons post-test. RESULTS An analysis of 21 participants was performed at Week 48 (96% male and 48% white; mean (range) age was 37 (23-78) years). No difference between arms was observed in ADP-, collagen- or thrombin receptor activator for peptide (TRAP)-6-evoked platelet αIIbβ3 integrin activation, granule release or platelet aggregation in response to any of the agonists tested. Despite differences in the demographics between treatment arms, the presence of an unboosted integrase inhibitor or boosted protease inhibitor in a test-and-treat setting did not impact platelet function. CONCLUSIONS Our study provides no evidence of differences in downstream platelet responses between participants taking BIC/F/TAF compared to DRV/c/F/TAF following 48 wk of treatment. Further data are required to explore whether there are biologically significant off-target effects, including effects on platelets and other components of the cardiovascular system between these two test-and-treat regimens. CLINICAL TRIAL NUMBER NCT04653194.
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Affiliation(s)
- Akif A Khawaja
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Merle Henderson
- Department of Infectious Disease, Imperial College London, London, UK
| | - Graham P Taylor
- Department of Infectious Disease, Imperial College London, London, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Michael Emerson
- National Heart and Lung Institute, Imperial College London, London, UK
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2
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Dash N, Manion M, Silverberg SL, Kitai I. Identification and Management of Paradoxical Reactions in Pediatric Tuberculosis. Pediatr Infect Dis J 2025; 44:e203-e206. [PMID: 40106771 DOI: 10.1097/inf.0000000000004805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Affiliation(s)
- Nabaneeta Dash
- From the Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maura Manion
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sarah L Silverberg
- From the Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation
| | - Ian Kitai
- From the Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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3
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Garland JM, Mayan H, Kantor R. Treatment of Advanced HIV in the Modern Era. Drugs 2025:10.1007/s40265-025-02181-1. [PMID: 40354016 DOI: 10.1007/s40265-025-02181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2025] [Indexed: 05/14/2025]
Abstract
Antiretroviral therapy has transformed human immunodeficiency virus (HIV) infection from a fatal illness into a manageable chronic condition. However, despite remarkable progress, the HIV epidemic remains a global health challenge, with ambitious targets such as 95-95-95 by 2030 at risk of being unmet. While antiretroviral therapy availability has expanded worldwide, gaps persist, including unawareness of HIV status, inconsistent medication uptake, and limited engagement in care across diverse settings. Advanced HIV represents a particularly challenging yet underexplored aspect of HIV care. Its definition is complex, complicating efforts to address the needs of this vulnerable population. This review characterizes advanced HIV populations, defines them by spectra of immune suppression, antiretroviral therapy exposure, and drug resistance, and explores contemporary approaches to their management, with a particular focus on drug resistance and its clinical implications in modern HIV care. It highlights the unique challenges faced by individuals presenting late to care, those with limited care engagement, and aging populations with long-term exposure to HIV and antiretroviral therapy. By defining these populations, refining our understanding of advanced HIV, and addressing the diverse needs of affected individuals, providers can enhance outcomes and develop strategies to overcome barriers to care. Bridging these critical gaps is essential to advancing global efforts to end the HIV epidemic, both in the USA and worldwide.
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Affiliation(s)
- Joseph M Garland
- The Miriam Hospital, Providence, RI, USA
- Brown University, Providence, RI, USA
| | - Haim Mayan
- Sheba Medical Center, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Rami Kantor
- The Miriam Hospital, Providence, RI, USA.
- Brown University, Providence, RI, USA.
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Koc H, Bayram U. Efficacy of Intravitreal Dexamethasone Implant in the Treatment of Immune Recovery Uveitis. Ocul Immunol Inflamm 2025:1-6. [PMID: 40265289 DOI: 10.1080/09273948.2025.2496977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Revised: 03/29/2025] [Accepted: 04/17/2025] [Indexed: 04/24/2025]
Abstract
PURPOSE To evaluate the efficacy of intravitreal dexamethasone in immune recovery uveitis (IRU) diagnosed with worsening of visual symptoms after recovery of cytomegalovirus (CMV) retinitis caused by acquired immunodeficiency syndrome (AIDS). METHODS A single case report was obtained from a tertiary referral center and retrospectively evaluated. RESULTS A 53-year-old male patient with known AIDS was admitted to our clinic with vision loss that started 1 month before and was diagnosed with CMV retinitis based on clinical findings (CD4 + T lymphocyte count 38 cells/μL). Two months after CMV retinitis regressed with treatment, the patient presented with decreased vision and had isolated bilateral cystoid macular edema, but no retinitis focus was observed. Considering the patient's CD4 + T lymphocyte count of 528 cells/μL and the fact that he was receiving HAART treatment, the patient was diagnosed with immune recovery uveitis. Intravitreal dexamethasone was administered to the patient who did not respond to three repeated doses of subtenon triamcinolone. After the intravitreal dexamethasone implant, the patient's clinical findings and bilateral cystoid macular edema regressed. No reactivation or side effects were observed. CONCLUSIONS Intravitreal dexamethasone therapy can be an effective and safe treatment for immune recovery uveitis that occurs after immune system recovery in AIDS patients and is resistant to topical or subtenon steroid treatment.
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Affiliation(s)
- Hakan Koc
- Department of Ophthalmology, Giresun University Faculty of Medicine, Giresun, Turkey
| | - Ugur Bayram
- Department of Ophthalmology, Giresun University Faculty of Medicine, Giresun, Turkey
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5
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Giordano L, Ware SA, Lagranha CJ, Kaufman BA. Mitochondrial DNA signals driving immune responses: Why, How, Where? Cell Commun Signal 2025; 23:192. [PMID: 40264103 PMCID: PMC12012978 DOI: 10.1186/s12964-025-02042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 01/14/2025] [Indexed: 04/24/2025] Open
Abstract
There has been a recent expansion in our understanding of DNA-sensing mechanisms. Mitochondrial dysfunction, oxidative and proteostatic stresses, instability and impaired disposal of nucleoids cause the release of mitochondrial DNA (mtDNA) from the mitochondria in several human diseases, as well as in cell culture and animal models. Mitochondrial DNA mislocalized to the cytosol and/or the extracellular compartments can trigger innate immune and inflammation responses by binding DNA-sensing receptors (DSRs). Here, we define the features that make mtDNA highly immunogenic and the mechanisms of its release from the mitochondria into the cytosol and the extracellular compartments. We describe the major DSRs that bind mtDNA such as cyclic guanosine-monophosphate-adenosine-monophosphate synthase (cGAS), Z-DNA-binding protein 1 (ZBP1), NOD-, LRR-, and PYD- domain-containing protein 3 receptor (NLRP3), absent in melanoma 2 (AIM2) and toll-like receptor 9 (TLR9), and their downstream signaling cascades. We summarize the key findings, novelties, and gaps of mislocalized mtDNA as a driving signal of immune responses in vascular, metabolic, kidney, lung, and neurodegenerative diseases, as well as viral and bacterial infections. Finally, we define common strategies to induce or inhibit mtDNA release and propose challenges to advance the field.
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Affiliation(s)
- Luca Giordano
- Center for Metabolism and Mitochondrial Medicine, Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA.
- Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Cardio-Pulmonary Institute (CPI), Justus-Liebig-University, Giessen, Germany.
| | - Sarah A Ware
- Center for Metabolism and Mitochondrial Medicine, Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Claudia J Lagranha
- Center for Metabolism and Mitochondrial Medicine, Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brett A Kaufman
- Center for Metabolism and Mitochondrial Medicine, Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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Nakano K, Kawashima A, Nakamoto T, Nakamichi K, Kuwata R, Abe S, Inoue E, Ando N, Uemura H, Mizushima D, Aoki T, Teruya K, Gatanaga H. Early diagnosis of progressive multifocal leukoencephalopathy in untreated HIV infection via ultrasensitive PCR testing for JC virus: A case report. IDCases 2025; 40:e02229. [PMID: 40297837 PMCID: PMC12036020 DOI: 10.1016/j.idcr.2025.e02229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 03/24/2025] [Accepted: 04/13/2025] [Indexed: 04/30/2025] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease triggered by the reactivation of JC virus (JCV) in individuals with immunodeficiency, particularly those with untreated human immunodeficiency virus (HIV) infection. This case report describes a 46-year-old HIV-positive man who initially presented with neurological symptoms and was incorrectly diagnosed as cerebral infarction. Although standard real-time polymerase chain reaction (PCR) testing for JCV in cerebrospinal fluid (CSF) at a commercial laboratory was negative, neuroimaging and clinical suspicion prompted ultrasensitive PCR testing at a national laboratory. This test detected a low viral load of JCV (28 copies/mL), confirming the diagnosis of PML. The patient underwent treatment with antiretroviral therapy and corticosteroids to prevent immune reconstitution inflammatory syndrome; however, his neurological symptoms persisted. This case highlights the importance of ultrasensitive CSF JCV testing for early PML diagnosis when standard PCR tests are inconclusive, particularly in HIV patients with atypically low JCV levels. It also highlights the diagnostic challenges of PML and emphasizes the clinical value of advanced PCR techniques for timely and accurate diagnosis in similar cases.
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Affiliation(s)
- Kenji Nakano
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Akira Kawashima
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
- The Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Takato Nakamoto
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
- The Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Kazuo Nakamichi
- Department of Virology 1, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan
| | - Ryo Kuwata
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Seitaro Abe
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Eri Inoue
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Naokatsu Ando
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Haruka Uemura
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Daisuke Mizushima
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
- The Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Takahiro Aoki
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Katsuji Teruya
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
- The Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
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Schregenberger S, Graup V, Schibli A, Preiswerk B, Laube I, Huber LC, Stüssi-Helbling M. Immune reconstitution inflammatory syndrome (IRIS): Case series and review of the literature. Respir Med Case Rep 2025; 55:102213. [PMID: 40276120 PMCID: PMC12019413 DOI: 10.1016/j.rmcr.2025.102213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2025] [Revised: 03/18/2025] [Accepted: 04/11/2025] [Indexed: 04/26/2025] Open
Abstract
Background Immune-reconstitution inflammatory syndrome (IRIS) is a dysregulated host inflammatory response following the initiation of appropriate therapy targeting an infectious disease. It is most commonly reported in human immunodeficiency virus patients following the initiation of antiretroviral therapy; however, IRIS can also be seen in immunocompromised patients without HIV, when the immune system is recovering. The diagnosis is confirmed using clinical and laboratory data after excluding differential diagnoses and concomitant infections. Case series Here, we describe three cases of patients with IRIS that were treated at our tertiary care center. The first case involves a paradoxical IRIS in an HIV-positive patient with TB, where the re-initiation of ART led to an inflammatory response despite effective anti-tuberculous treatment (ATT). The second case highlights unmasking IRIS in an HIV-positive patient, where the initiation of ART revealed an underlying Epstein-Barr virus (EBV)-associated B-cell lymphoma. The third case describes paradoxical worsening of pulmonary TB in an HIV-negative patient, expanding the scope of IRIS beyond its conventional association with HIV infection. Conclusion These cases illustrate the various manifestations of IRIS and emphasize the need for timely diagnosis and appropriate management strategies to mitigate the potentially severe outcomes associated with this syndrome. Our report highlights the challenges faced in the diagnosis of IRIS which impede prompt onset of therapy.
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Affiliation(s)
- Sebastian Schregenberger
- Department of Surgery, Division of Emergency Medicine, Hospital Buelach, Spitalstrasse 24, 8180, Buelach, Switzerland
| | - Vera Graup
- Department of Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Adrian Schibli
- Department of Internal Medicine, Division of Infectious Diseases and Infection Prevention, City Hospital Zurich, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Benjamin Preiswerk
- Department of Internal Medicine, Division of Infectious Diseases and Infection Prevention, City Hospital Zurich, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Irène Laube
- Department of Internal Medicine, Division of Pulmonology, City Hospital Zurich, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Lars C. Huber
- Department of Internal Medicine, Clinic for Internal Medicine, City Hospital Zurich, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
| | - Melina Stüssi-Helbling
- Department of Internal Medicine, Clinic for Internal Medicine, City Hospital Zurich, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
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Luce AE, Drak Alsibai K, Thorey C, Guttierez B, Demar M, Blaizot R, Grotta G. Cutaneous leishmaniasis as immune reconstitution syndrome: A clinical and histopathological case series. J Eur Acad Dermatol Venereol 2025; 39:e310-e312. [PMID: 39136600 DOI: 10.1111/jdv.20285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 08/05/2024] [Indexed: 03/26/2025]
Affiliation(s)
| | - Kinan Drak Alsibai
- Histopathology Department, Cayenne Hospital, Cayenne, French Guiana
- UMR 1019 TBIP Tropical Biomes and Immunophysiopathology, University of French Guiana, Cayenne, French Guiana
| | - Camille Thorey
- Infectious Diseases Department, West French Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - Blandine Guttierez
- Infectious Diseases Department, West French Guiana Hospital, Saint-Laurent-du-Maroni, French Guiana
| | - Magalie Demar
- UMR 1019 TBIP Tropical Biomes and Immunophysiopathology, University of French Guiana, Cayenne, French Guiana
- Parasitology Department, Cayenne Hospital Center, Cayenne, French Guiana
| | - Romain Blaizot
- Dermatology Department, Cayenne Hospital, Cayenne, French Guiana
- UMR 1019 TBIP Tropical Biomes and Immunophysiopathology, University of French Guiana, Cayenne, French Guiana
| | - Geoffrey Grotta
- Dermatology Department, Cayenne Hospital, Cayenne, French Guiana
- Histopathology Department, Cayenne Hospital, Cayenne, French Guiana
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9
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Cohen R, Ostrovsky V, Zornitzki L, Elbirt D, Zornitzki T. Exploring a Rare Association: Systematic Review of Hypercalcemia in Nontuberculous Mycobacterial Infections. Microorganisms 2025; 13:773. [PMID: 40284609 PMCID: PMC12029202 DOI: 10.3390/microorganisms13040773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2025] [Revised: 02/22/2025] [Accepted: 02/26/2025] [Indexed: 04/29/2025] Open
Abstract
Hypercalcemia represents a rare complication of nontuberculous Mycobacterium (NTM) infections, particularly in individuals with human immunodeficiency virus (HIV) positivity. This systematic review examines NTM infections associated with hypercalcemia, including the presentation of a novel and illustrative case of Mycobacterium simiae. A meticulous literature search identified 24 cases relevant to this phenomenon (11 HIV-positive and 13 non-HIV), which were included in the analysis. Key clinical and laboratory findings reveal significant contrasts between HIV-positive and non-HIV patients. In the HIV-positive cohort, hypercalcemia is commonly developed after the initiation of highly active antiretroviral therapy (HAART) or treatment for NTM infections despite severe underlying immunosuppression. Conversely, in the non-HIV group, a spectrum of immunosuppressive conditions, including chronic renal failure and prolonged use of immunosuppressive drugs, was implicated in the pathogenesis of NTM infections with hypercalcemia. Two distinct mechanistic pathways likely underlie this association. In HIV-positive patients, immune restoration following HAART appears to drive granuloma formation and excessive 1,25-dihydroxyvitamin D production. In non-HIV individuals, prolonged immune suppression may facilitate macrophage activation associated with NTM infections, thereby contributing to hypercalcemia. Treatment strategies varied and included bisphosphonates, corticosteroids, and hemodialysis. Notably, bisphosphonates emerged as a safe and effective option in most cases. Antibiotic therapy was deemed unnecessary when hypercalcemia was the sole symptom of NTM infection. This review underscores the importance of recognizing hypercalcemia as a potential complication of NTM infections and tailoring management strategies to the patient's underlying immunological status.
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Affiliation(s)
- Ramon Cohen
- Internal Medicine Department B, Kaplan Medical Center, Hebrew University Medical School, Rehovot 76100, Israel
- Department of Clinical Immunology, Allergy, and AIDS, Kaplan Medical Center, Hebrew University Medical School, Rehovot 76100, Israel
| | - Viviana Ostrovsky
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School, Rehovot 76100, Israel
| | - Lior Zornitzki
- Division of Cardiology, Tel-Aviv Sourasky Medical Center, School of Medicine, Tel-Aviv University, Tel-Aviv 46239, Israel
| | - Daniel Elbirt
- Department of Clinical Immunology, Allergy, and AIDS, Kaplan Medical Center, Hebrew University Medical School, Rehovot 76100, Israel
| | - Taiba Zornitzki
- Diabetes, Endocrinology and Metabolic Disease Institute, Kaplan Medical Center, Hebrew University Medical School, Rehovot 76100, Israel
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10
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Inada S, Omori K, Nomura T, Kitagawa H, Shigemoto N, Hattori N, Ohge H. Non-tuberculous mycobacterial shoulder arthritis with acute exacerbation soon after initiation of immune checkpoint inhibitor: A case report. J Infect Chemother 2025; 31:102596. [PMID: 39710166 DOI: 10.1016/j.jiac.2024.102596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 10/03/2024] [Accepted: 12/19/2024] [Indexed: 12/24/2024]
Abstract
Immune checkpoint inhibitors (ICIs) have been approved for treating various cancers; however, they can cause immune-related adverse events. Generally, ICIs are not associated with an increased risk of infection, however, several reports demonstrated infections caused by non-tuberculous mycobacterium (NTM) during ICI therapy. Here, we report a case of NTM shoulder arthritis with acute exacerbation immediately after ICI initiation. A 75-year-old man was diagnosed with left shoulder arthritis caused by Mycobacterium intracellulare eight months before receiving ICI treatment and was treated with clarithromycin and ethambutol. However, the mild redness, swelling, heat, and shoulder pain persisted. The patient was diagnosed with hepatocellular carcinoma and atezolizumab and bevacizumab treatment was initiated; one day after the initiation of therapy, the patient presented with a fever and worsened shoulder symptoms. Considering the suspected worsening of NTM arthritis, sitafloxacin was additionally administered, and surgical debridement was performed. M. intracellulare was isolated through culturing shoulder synovial tissue; immunohistochemical staining analysis revealed programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1) expression in granulation tissue cells. After the arthritis symptoms decreased, atezolizumab plus bevacizumab was resumed and continued with no recurrence of arthritis. The NTM exacerbation on the day after ICI administration suggests the potential involvement of the PD-1/PD-L1 pathway in the pathogenesis of NTM; moreover, adverse inflammatory reactions to NTM were possibly triggered through the blockade of this pathway.
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Affiliation(s)
- Shugo Inada
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keitaro Omori
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Toshihito Nomura
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroki Kitagawa
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Norifumi Shigemoto
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan; Translational Research Center, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
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11
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Kaya A, Özdemir G, Başaran SF, Özgümüş T, Koç B, Mert A. A Case of HIV with Unmasked Kaposi's Sarcoma IRIS and Drug-Resistant Tuberculosis. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2025; 7:106-108. [PMID: 40225709 PMCID: PMC11991703 DOI: 10.36519/idcm.2025.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Accepted: 12/18/2024] [Indexed: 04/15/2025]
Abstract
In this paper, we present a case of disseminated tuberculosis in a 25-year-old male patient infected with the human immunodeficiency virus. Following steroid treatment, the patient subsequently developed cutaneous lesions of Kaposi's sarcoma. A culture yielded Mycobacterium tuberculosis complex that was sensitive to ethambutol but resistant to isoniazid, rifampicin, and streptomycin. Despite intensive treatment, the patient eventually succumbed to organ failure in hospital.
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Affiliation(s)
- Abdurrahman Kaya
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Training and Research Hospital, İstanbul, Türkiye
| | - Gülhan Özdemir
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Training and Research Hospital, İstanbul, Türkiye
| | - Süleyman Furkan Başaran
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Training and Research Hospital, İstanbul, Türkiye
| | - Tuba Özgümüş
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Training and Research Hospital, İstanbul, Türkiye
| | - Buse Koç
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Training and Research Hospital, İstanbul, Türkiye
| | - Ali Mert
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medipol University School of Medicine, İstanbul, Türkiye
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12
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Attia EF, Maleche-Obimbo E, Ellington LE, North CM. Pulmonary Immunocompromise in Human Immunodeficiency Virus Disease. Clin Chest Med 2025; 46:185-201. [PMID: 39890288 PMCID: PMC12044705 DOI: 10.1016/j.ccm.2024.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
The spectrum of pulmonary disease in people with human immunodeficiency virus (PWH) across the lifespan has shifted from acute, infectious, and acquired immunodeficiency syndrome (AIDS)-defining illnesses to a greater burden of chronic, non-communicable processes. Here, the authors review the epidemiology and risk factors of pulmonary disease in PWH across the lifespan during the contemporary antiretroviral therapy era. The authors focus on recommendations for clinical care of pulmonary disease relevant to PWH, including emerging data from recent and ongoing clinical trials.
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Affiliation(s)
- Engi F Attia
- Division of Pulmonary, Critical Care and Sleep Medicine, Departments of Medicine and Global Health, University of Washington School of Medicine, Seattle, WA, USA.
| | | | - Laura E Ellington
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, WA, USA
| | - Crystal M North
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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13
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Song W, Liu L, Qi T, Wang Z, Tang Y, Sun J, Xu S, Yang J, Wang J, Chen J, Zhang R, Shen Y. Analysis of intracranial lesions in patients with HIV-associated cryptococcal meningitis. Front Cell Infect Microbiol 2025; 15:1446470. [PMID: 39963413 PMCID: PMC11830730 DOI: 10.3389/fcimb.2025.1446470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 01/14/2025] [Indexed: 02/20/2025] Open
Abstract
Background Intracranial imaging abnormalities are commonly observed in patients suffering from HIV-associated cryptococcal meningitis, both before and during the treatment period. This study aims to analyze the prevalence, origins, radiological characteristics, treatments, and prognosis of intracranial lesions in patients with HIV-associated cryptococcal meningitis, thereby providing references for future clinical decision-making. Methods The clinical data of patients diagnosed with HIV-associated cryptococcal meningitis and admitted to the Shanghai Public Health Clinical Centre between 2013 and 2019 were collected. Logistic regression analysis was subsequently conducted to identify potential risk factors associated with the development of intracranial lesions in this patient group. Results Of 211 patients analyzed, 64.5% (136/211) had intracranial lesions during treatment and follow-up. Initial cranial imaging showed 60% had lesions pre-treatment. Throughout treatment, 32.7% (52/159) developed new or worsened lesions. Mortality rates at 2 weeks, 8 weeks, and 2 years for those with detected lesions were 3%, 7.6%, and 13.2%, respectively. Lesions were primarily caused by Cryptococcus (70.5%) and Mycobacterium (24.3%). Lacunar infarcts, especially in the basal ganglia, were the most common type. Patients aged 50 years or older, and those presenting with altered mental status upon admission, were found to be more likely to have intracranial lesions at baseline, with adjusted odds ratios of 5.364 (95% CI: 1.468-19.591, P=0.011) and 7.970 (95% CI: 2.241-28.337, P=0.001), respectively. Patients with lesion progression showed higher levels of IFN-γ, IL-4, IL-5, IL-6, IL-1Ra, IL-1β, GM-CSF, Eotaxin, and Basic FGF in cerebrospinal fluid after four weeks of treatment. Conclusion Intracranial lesions in HIV-associated cryptococcal meningitis patients are mostly due to Cryptococcus and Mycobacterium infections. They often appear as lacunar infarcts, predominantly in the basal ganglia, and can worsen with treatment initiation, possibly due to higher baseline cytokine levels in cerebrospinal fluid.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Yinzhong Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Kim JH, Cho MH, Ban JH, Lee SH, Lee JS. Ocular Manifestations of Immune Reconstitution Inflammatory Syndrome in HIV after Highly Active Antiretroviral Therapy: Clinical Use of CD8+ T cell. KOREAN JOURNAL OF OPHTHALMOLOGY 2025; 39:71-79. [PMID: 39828283 PMCID: PMC11856080 DOI: 10.3341/kjo.2024.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 01/12/2025] [Accepted: 01/17/2025] [Indexed: 01/22/2025] Open
Abstract
PURPOSE To investigate ocular manifestation of immune reconstitution inflammatory syndrome (IRIS) in HIV patients after starting highly active antiretroviral therapy (HAART) and its relationship to T cell immunity. METHODS HIV patients with ocular IRIS after HAART were retrospectively reviewed. Clinical presentations with previous opportunistic infection, duration from initiation of HAART to IRIS, blood CD4+, CD8+ T cell count, and HIV RNA copies before HAART and at IRIS were analyzed. RESULTS Among 19 patients (27 eyes) included, the most common previous opportunistic infection was cytomegalovirus (17 patients, 89.5%) followed by tuberculosis choroiditis (2 patients, 10.5%). The clinical manifestations included vitritis (20 eyes, 74.0%), retinitis (14 eyes, 51.9%), and anterior uveitis (5 eyes, 18.5%). The median duration from initiation of HAART to IRIS was 70 days. CD4+ T cell count before HAART increased at IRIS (p < 0.001). CD8+ T cell count before HAART was negatively correlated with duration from HAART to IRIS (p < 0.001). The cutoff value of CD8+ T cell count for discerning early or late onset of ocular IRIS was 258/mm3 (p = 0.001). When divided into two groups by CD8+ T cell count of 258/mm3, 90% patients with CD8+ T cell count higher than 258/mm3 before HAART developed ocular IRIS within 70 days. CONCLUSIONS There was a negative relationship between CD8+ T cell count before HAART and duration from HAART to ocular IRIS. Ocular IRIS with higher CD8+ T cell count before HAART developed earlier after HAART initiation compared to those with lower CD8+ T cell count.
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Affiliation(s)
- Jae Hyun Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Busan,
Korea
| | - Myung Ho Cho
- Department of Ophthalmology, Pusan National University School of Medicine, Busan,
Korea
| | - Ji Hoon Ban
- Department of Ophthalmology, Pusan National University School of Medicine, Busan,
Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan,
Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Busan,
Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan,
Korea
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15
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Reverón DR, Flora-Noda DM, Soto LM, Dolande M, Frey J, Chaurio A, Ruiz-Alayón BD, Caldera J, Carrión-Nessi FS, Forero-Peña DA. Disseminated nocardiosis in a patient with AIDS and B-cell non-Hodgkin's lymphoma: a case report. BMC Infect Dis 2025; 25:30. [PMID: 39762755 PMCID: PMC11702207 DOI: 10.1186/s12879-024-10413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 12/26/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Disseminated nocardiosis is a rare and potentially fatal disease, with a higher incidence in immunocompromised patients, such as those living with human immunodeficiency virus (HIV) or hematological malignancies, including lymphoma. Information on Nocardia spp. infection in Venezuela is limited. CASE PRESENTATION We present the case of a 62-year-old male patient, recently diagnosed with HIV, who exhibited prolonged fever and unintentional weight loss. Paraclinical tests revealed pancytopenia and a marked elevation of lactate dehydrogenase. Disseminated histoplasmosis was suspected, prompting a bone marrow (BM) aspirate. Culture and molecular studies for Histoplasma spp. and Mycobacterium tuberculosis in BM samples were negative. Antiretroviral therapy with tenofovir/lamivudine/dolutegravir was initiated, but the patient subsequently experienced clinical deterioration, including ascites, pericardial effusion, and respiratory failure. Post-mortem biopsy and immunohistochemistry identified non-Hodgkin's lymphoma of B-cell lineage, and mycological culture of BM isolated Nocardia farcinica. CONCLUSION Disseminated nocardiosis may mimic histoplasmosis. Nocardia spp. infection should be considered in HIV patients, particularly in advanced stages of infection.
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Affiliation(s)
- Delvis R Reverón
- Department of Infectious Diseases, Hospital Universitario de Caracas, Caracas, Venezuela
| | - David M Flora-Noda
- Department of Infectious Diseases, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Lily M Soto
- Department of Infectious Diseases, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Maribel Dolande
- Department of Mycology, Instituto Nacional de Higiene "Rafael Rangel", Caracas, Venezuela
| | - Juan Frey
- Department of Mycology, Instituto Nacional de Higiene "Rafael Rangel", Caracas, Venezuela
| | - Aleiram Chaurio
- Department of Mycology, Instituto Nacional de Higiene "Rafael Rangel", Caracas, Venezuela
| | - Bárbara D Ruiz-Alayón
- Department of Internal Medicine, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Jocays Caldera
- Department of Infectious Diseases, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Fhabián S Carrión-Nessi
- "Luis Razetti" School of Medicine, Universidad Central de Venezuela, Caracas, Venezuela.
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolívar, Venezuela.
| | - David A Forero-Peña
- Department of Infectious Diseases, Hospital Universitario de Caracas, Caracas, Venezuela.
- "Luis Razetti" School of Medicine, Universidad Central de Venezuela, Caracas, Venezuela.
- Biomedical Research and Therapeutic Vaccines Institute, Ciudad Bolívar, Venezuela.
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16
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Corbett C, van Rensburg R, Brey N, O'Hagan S, Esterhuizen TM, Chow FC, Decloedt EH. Timing of ART Initiation Associated With HIV-Associated Stroke. J Acquir Immune Defic Syndr 2025; 98:e1-e3. [PMID: 39288941 DOI: 10.1097/qai.0000000000003529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Affiliation(s)
- Craig Corbett
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Medicine, Paarl Hospital, Paarl, Western Cape, South Africa
| | - Roland van Rensburg
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Naeem Brey
- Division of Neurology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Suzanne O'Hagan
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Cape Town, Western Cape, South Africa
| | - Tonya M Esterhuizen
- Biostatistics Unit, Division of Epidemiology and Biostatistics, Cape Town, Western Cape, South Africa
| | - Felicia C Chow
- Departments of Neurology and Medicine (Infectious Diseases), University of California San Francisco, San Francisco, CA
| | - Eric H Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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17
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Amanati A, Jahromi MG, Jafarian H, Abdipour Mehrian SR, Sajedianfard S, Farokhmanesh S, Maddahi A, Safari F, Nabavizadeh SA, Alinazari MMK. Aspergillus-related immune reconstitution inflammatory syndrome in pediatric cancer patients, clinical characteristics, imaging findings, and survival. BMC Infect Dis 2024; 24:1423. [PMID: 39696082 PMCID: PMC11653824 DOI: 10.1186/s12879-024-10298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 12/02/2024] [Indexed: 12/20/2024] Open
Abstract
Aspergillus-related immune reconstitution inflammatory syndrome (IRIS) is a challenge to diagnose in immunocompromised pediatric cancer patients with Invasive Pulmonary Aspergillosis (IPA). If not recognized, it can mimic disease progression and lead to overtreatment. Studies on Aspergillus-related IRIS in the pediatric population are scarce. We prospectively identified four pediatric cancer patients diagnosed with IPA who developed paradoxical worsening of pulmonary symptoms following neutrophil recovery. The clinical course, imaging findings, and response to corticosteroids were also reviewed. All patients had refractory respiratory symptoms, including cough, breathing difficulties (dyspnea), and chest pain, despite antifungal therapy. Serial imaging revealed new or enlarging pulmonary infiltrates. Symptoms improved dramatically with corticosteroids without antifungal escalation, confirming Aspergillus-related IRIS diagnosis. Aspergillus-related IRIS can occur in immunocompromised children with cancer and IPA, mimicking disease progression. Recognition is important for avoiding overtreatment. This is the first report highlighting the features of Aspergillus-related IRIS in pediatric cancer patients.
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Affiliation(s)
- Ali Amanati
- Shiraz University of Medical Sciences, Shiraz, Iran
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Ghaderian Jahromi
- Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadis Jafarian
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Shahdad Farokhmanesh
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arman Maddahi
- Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farima Safari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, 71-348-45794, Iran.
| | - Seyed Ali Nabavizadeh
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, 71-348-45794, Iran.
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18
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Kawajiri A, Li J, Koinuma K, Yang Z, Yoon HJ, Yi J, Nagashima H, Ishii M, Gao F, Sato K, Tayama S, Harigae H, Iwakura Y, Ishii N, Sher A, Ishigaki K, Zhu J, Kim KS, Kawabe T. Naturally arising memory-phenotype CD4 + T lymphocytes contain an undifferentiated population that can generate T H1, T H17, and T reg cells. SCIENCE ADVANCES 2024; 10:eadq6618. [PMID: 39630890 PMCID: PMC11619248 DOI: 10.1126/sciadv.adq6618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 10/29/2024] [Indexed: 12/07/2024]
Abstract
Memory-phenotype (MP) CD4+ T lymphocytes develop from naïve cells via self-recognition at homeostasis. While previous studies defined MP cells as a heterogeneous population that comprises T helper 1 (TH1)/17-like subsets, functional significance of the T-bet- Rorγt- subpopulation remains unknown. Here we show that MP lymphocytes as a whole population can differentiate into TH1/17/regulatory T (Treg) cells to mediate mild and persistent inflammation in lymphopenic environments, whereas naïve cells exhibit strong, TH1-dominated responses. Moreover, we demonstrate that MP lymphocytes comprise not only TH1/17-differentiated subsets but a polyclonal, transcriptomically immature "undifferentiated" subpopulation at homeostasis. Furthermore, our data argue that while the T-bet+ Rorγt- MP subset is terminally TH1-differentiated, its undifferentiated counterpart retains the capacity to rapidly proliferate to differentiate into TH1/17/Treg cells, with the latter response tonically constrained by preexisting Treg cells. Together, our results identify undifferentiated MP CD4+ T lymphocytes as a unique precursor that has a diverse differentiation potential to generate TH1/17/Treg cells to contribute to pathogenesis of inflammation.
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Affiliation(s)
- Akihisa Kawajiri
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Hematology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Jing Li
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Keita Koinuma
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ziying Yang
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hye Jin Yoon
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Jaeu Yi
- Department of Internal Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Biological Science, Ajou University, Suwon, Republic of Korea
| | - Hiroyuki Nagashima
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Minami Ishii
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Feng Gao
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kosuke Sato
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shunichi Tayama
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hideo Harigae
- Department of Hematology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoichiro Iwakura
- Center for Animal Disease Models, Research Institute for Biomedical Sciences, Tokyo University of Science, Noda, Chiba, Japan
| | - Naoto Ishii
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Alan Sher
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kazuyoshi Ishigaki
- Laboratory for Human Immunogenetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa, Japan
| | - Jinfang Zhu
- Molecular and Cellular Immunoregulation Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kwang Soon Kim
- Department of Life Sciences, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Takeshi Kawabe
- Department of Microbiology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Molecular and Cellular Immunoregulation Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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19
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Dash N, Jain L, Malik M, Pradhan P, Choudhary M, Mandula PP, Kaur K, Purohit A, Mathew JL. Paradoxical Reaction to Tuberculosis Therapy among HIV-Negative Children: A Systematic Review and Meta-Analysis. Am J Trop Med Hyg 2024; 111:1273-1279. [PMID: 39293426 PMCID: PMC11619483 DOI: 10.4269/ajtmh.24-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/13/2024] [Indexed: 09/20/2024] Open
Abstract
Tuberculosis treatment is sometimes associated with clinical deterioration, referred to as paradoxical reaction (PR), especially in those with HIV coinfection. However, the burden and characteristics of PR in children without HIV coinfection are unclear. We undertook a systematic review to estimate the burden and clinical characteristics of PR in HIV-negative children. We searched PubMed, Embase, Web of Science, CINAHL, Scopus, Cochrane Library, ProQuest, and OpenGrey for studies reporting PR in HIV-negative children (<18 years old). We included observational studies including case series with at least five cases. Data on incidence/prevalence, clinical features, risk factors, management strategies, and outcome of PR were extracted. Risk of bias in the included studies was assessed using the NIH's quality assessment and Joanna Briggs Institute critical appraisal tools. We pooled the prevalence data using random effects meta-analysis. We identified 1,673 studies, of which 10 were eligible for inclusion. They described PR in 133 HIV-negative children. The pooled prevalence was 8.8% (95% CI: 2.9%, 14.6%). Owing to heterogeneity among studies, risk factors for the development of PR could not be identified. Limited data suggested that children developing PR were younger and had neurological or lymph node tuberculosis more often. Most children were treated with corticosteroids, but data were insufficient to identify the optimal management strategy. The review showed that PR affects nearly 1 in 12 HIV-negative children receiving tuberculosis treatment. The paucity of studies emphasizes the need for surveillance/studies to better characterize clinical features, risk factors, appropriate management strategies, and outcome.
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Affiliation(s)
- Nabaneeta Dash
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Lovely Jain
- Advanced Centre for Evidence Based Child Health (ACEBCH), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Meenakshi Malik
- Advanced Centre for Evidence Based Child Health (ACEBCH), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pranita Pradhan
- Advanced Centre for Evidence Based Child Health (ACEBCH), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Monica Choudhary
- Advanced Centre for Evidence Based Child Health (ACEBCH), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Phani Priya Mandula
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kulbir Kaur
- Advanced Centre for Evidence Based Child Health (ACEBCH), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Abhishek Purohit
- Advanced Centre for Evidence Based Child Health (ACEBCH), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Joseph L. Mathew
- Advanced Centre for Evidence Based Child Health (ACEBCH), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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20
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Libby P, Smith R, Rubin EJ, Glassberg MK, Farkouh ME, Rosenson RS. Inflammation unites diverse acute and chronic diseases. Eur J Clin Invest 2024; 54:e14280. [PMID: 39046830 DOI: 10.1111/eci.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/10/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Inflammation and immunity contribute pivotally to diverse acute and chronic diseases. Inflammatory pathways have become increasingly targets for therapy. Yet, despite substantial similarity in mechanisms and pathways, the scientific, medical, pharma and biotechnology sectors have generally focused programs finely on a single disease entity or organ system. This insularity may impede progress in innovation and the harnessing of powerful new insights into inflammation biology ripe for clinical translation. METHODS A multidisciplinary thinktank reviewed highlights how inflammation contributes to diverse diseases, disturbed homeostasis, ageing and impaired healthspan. We explored how common inflammatory and immune mechanisms that operate in key conditions in their respective domains. This consensus review highlights the high degree of commonality of inflammatory mechanisms in a diverse array of conditions that together contribute a major part of the global burden of morbidity and mortality and present an enormous challenge to public health and drain on resources. RESULTS We demonstrate how that shared inflammatory mechanisms unite many seemingly disparate diseases, both acute and chronic. The examples of infection, cardiovascular conditions, pulmonary diseases, rheumatological disorders, dementia, cancer and ageing illustrate the overlapping pathogenesis. We outline opportunities to synergize, reduce duplication and consolidate efforts of the clinical, research and pharmaceutical communities. Enhanced recognition of these commonalties should promote cross-fertilization and hasten progress in this rapidly moving domain. CONCLUSIONS Greater appreciation of the shared mechanisms should simplify understanding seemingly disparate diseases for clinicians and help them to recognize inflammation as a therapeutic target which the development of novel therapies is rendering actionable.
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Affiliation(s)
- Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Eric J Rubin
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Michael E Farkouh
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
- Peter Munk Centre of Excellence in Multinational Clinical Trials, University Health Network, Toronto, Ontario, Canada
| | - Robert S Rosenson
- Cardiometabolics Unit, Mount Sinai Icahn School of Medicine, Mount Sinai Hospital, New York, New York, USA
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Chagomerana MB, Moser CB, Kang M, Umbleja T, Hughes MD, Campbell TB, Krown SE, Borok MZ, Samaneka W, Ngongondo M, Nyirenda M, Langat DC, Hoagland B, Burger H, Busakhala N, Njiru E, Mwelase N, Mngqibisa R, Hosseinipour MC. Mortality and Associated Risk Factors Among People Living With HIV With Kaposi Sarcoma: A5263/AMC066 and A5264/AMC067. J Acquir Immune Defic Syndr 2024; 97:216-225. [PMID: 39431505 PMCID: PMC11494148 DOI: 10.1097/qai.0000000000003484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/03/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND AIDS-related Kaposi sarcoma (AIDS-KS) remains a leading cause of morbidity and mortality among people living with HIV in Africa. Mortality among people with AIDS-KS on antiretroviral therapy remains high compared with people on antiretroviral therapy who do not have AIDS-KS. SETTING People living with HIV with Kaposi sarcoma (KS) who participated in 2 randomized trials (A5263/AMC066 [advanced stage] and A5264/AMC067 [mild-to-moderate stage]) conducted by AIDS Clinical Trials Group/AIDS Malignancy Consortium in low- and middle-income countries. METHODS We estimated mortality rates over the trial period. Cox proportional hazards regressions were used to identify baseline characteristics associated with mortality and compared mortality rates between participants who had KS progression within 12 weeks of treatment initiation (early progression of KS [KS-PD]) and those who did not. RESULTS Of the 329 and 189 eligible participants in A5263/AMC066 and A5264/AMC067, 71 (21.6%) and 24 (12.7%) died, respectively. In both trials, hypoalbuminemia was associated with increased hazards of death compared with normal albumin; A5263/AMC066: mild hypoalbuminemia (adjusted hazard ratio [aHR] = 3.01; 95% CI: 1.42 to 6.29), moderate hypoalbuminemia (aHR = 5.11; 95% CI: 2.54 to 10.29), and severe hypoalbuminemia (aHR = 14.58; 95% CI: 6.32 to 35.60), and A5264/AMC067: mild hypoalbuminemia (aHR = 5.66; 95% CI: 1.90 to 16.93) and moderate hypoalbuminemia (aHR = 7.02; 95% CI: 2.57 to 19.15). The rate of death was higher among participants who had early KS-PD than those without early KS-PD in A5263/AMC066 (HR = 5.09; 95% CI: 1.71 to 15.19) but not in A5264/AMC067 (HR = 1.74; 95% CI: 0.66 to 4.62). CONCLUSIONS Albumin measurements may be used to identify individuals at higher risk of death after initiating KS treatment and for evaluation of interventions that can reduce AIDS-KS mortality.
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Affiliation(s)
- Maganizo B. Chagomerana
- UNC Project, Lilongwe, Malawi
- UNC Department of Medicine, University of North Carolina at Chapel Hill, USA
| | - Carlee B. Moser
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, USA
| | - Minhee Kang
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, USA
| | - Triin Umbleja
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, USA
| | - Michael D. Hughes
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, USA
| | | | | | - Margaret Z. Borok
- University of Zimbabwe, Faculty of Medicine and Health Sciences, Zimbabwe
| | - Wadzanai Samaneka
- University of Zimbabwe, Faculty of Medicine and Health Sciences, Zimbabwe
| | | | - Mulinda Nyirenda
- Johns Hopkins Research Project, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Deborah C. Langat
- Kenya Medical Research Institute/Walter Reed Project, Kericho, Kenya
| | | | - Henriette Burger
- Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic hospital, Cape Town, South Africa
| | | | | | | | | | - Mina C. Hosseinipour
- UNC Project, Lilongwe, Malawi
- UNC Department of Medicine, University of North Carolina at Chapel Hill, USA
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22
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Duffus E, Chinta S, Patel P, Finkel DG. Coinfection of cerebral toxoplasmosis and neurosyphilis as the first manifestation of AIDS. BMJ Case Rep 2024; 17:e261502. [PMID: 39299714 DOI: 10.1136/bcr-2024-261502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024] Open
Abstract
A male in his 30s with a medical history of newly diagnosed HIV with a CD4 count of 292 cells/mm3 presented with a bilateral frontal headache and left upper and lower extremity weakness and paraesthesias. A few months prior, the patient experienced a desquamating rash on his scalp and a pruritic, papular genital rash, which both self-resolved. CT head without contrast revealed extensive vasogenic oedema involving the right basal ganglia, thalamus, temporal and occipital lobes. MRI of the brain with and without contrast revealed two enhancing masses in the right lentiform nucleus and right temporal-occipital junction with associated vasogenic oedema. Cerebrospinal fluid (CSF) studies confirmed cerebral toxoplasmosis with positive CSF Toxoplasma gondii PCR and neurosyphilis with positive serum rapid plasma reagin and CSF venereal disease research laboratory test. He was treated with trimethoprim/sulfamethoxazole and intravenous penicillin G with the resolution of his symptoms.
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Affiliation(s)
- Emily Duffus
- Internal Medicine/Pediatrics, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sree Chinta
- Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Pooja Patel
- Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Diana G Finkel
- Department of Medicine, Division of Infectious Disease, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Choi W, Lauwers GY, Slavik T. Inflammatory disorders of the stomach. MORSON AND DAWSON'S GASTROINTESTINAL PATHOLOGY 2024:135-194. [DOI: 10.1002/9781119423195.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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24
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Zaongo SD, Zongo AW, Chen Y. Mechanisms underlying the development of type 1 diabetes in ART-treated people living with HIV: an enigmatic puzzle. Front Immunol 2024; 15:1470308. [PMID: 39257582 PMCID: PMC11383789 DOI: 10.3389/fimmu.2024.1470308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 08/12/2024] [Indexed: 09/12/2024] Open
Abstract
The immunopathogenesis of HIV infection remains poorly understood. Despite the widespread use of effective modern antiretroviral therapy (ART), people living with HIV (PLWH) are known to develop several comorbidities, including type 1 diabetes (T1DM). However, the etiology and critical mechanisms accounting for the onset of T1DM in the preceding context remain unknown. This article proposes to address this topic in order to provide further understanding and future research directions.
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Affiliation(s)
- Silvere D Zaongo
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Abel W Zongo
- College of Food Science and Technology, Zhejiang University of Technology, Hangzhou, China
| | - Yaokai Chen
- Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
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25
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de Medeiros Rimkus C, Fragoso DC, Apóstolos Pereira SL, da Costa Leite C. Atypical Demyelinating Disorders: MR Imaging Features, Atypical Triggers, and Etiopathogenesis. Neuroimaging Clin N Am 2024; 34:421-438. [PMID: 38942525 DOI: 10.1016/j.nic.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Atypical demyelinating lesions (ADLs) can be idiopathic, occurring as isolated and self-limited events, or can appear in different stages of relapsing demyelinating diseases. Not infrequently, ADLs occur in inflammatory syndromes associated with exogenous or endogenous toxic factors, metabolic imbalance, or infectious agents. It is important to recognize imaging patterns that indicate an inflammatory/demyelinating substrate in central nervous system lesions and to investigate potential triggers or complicating factors that might be associated. The prognostic and treatment strategies of ADLs are influenced by the underlying etiopathogenesis.
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Affiliation(s)
- Carolina de Medeiros Rimkus
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 75, Cerqueira Cesar, São Paulo-SP, 05403-010, Brazil; Instituto D'Or de Ensino e Pesquisa (IDOR), Av. Brigadeiro Luís Antônio, 5001 - Jardim Paulista, São Paulo - SP - CEP 01401-002; MS Center, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan, 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Diego Cardoso Fragoso
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 75, Cerqueira Cesar, São Paulo-SP, 05403-010, Brazil; Fleury Group, Av. Morumbi, 8860 - Jardim das Acacias, São Paulo - SP, 04580-060, Brazil
| | - Samira Luisa Apóstolos Pereira
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 - Sala 5083, 5° andar - Cerqueira César, São Paulo-SP, 05402-000, Brazil
| | - Claudia da Costa Leite
- Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, R. Dr. Ovídio Pires de Campos, 75, Cerqueira Cesar, São Paulo-SP, 05403-010, Brazil; Fleury Group, Av. Morumbi, 8860 - Jardim das Acacias, São Paulo - SP, 04580-060, Brazil
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26
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Rodrigues Alves N, Barão C, Mota C, Costa L, Proença RP. Immune recovery uveitis: a focus review. Graefes Arch Clin Exp Ophthalmol 2024; 262:2703-2712. [PMID: 38381160 PMCID: PMC11271330 DOI: 10.1007/s00417-024-06415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/23/2023] [Accepted: 02/11/2024] [Indexed: 02/22/2024] Open
Abstract
Immune recovery uveitis (IRU) is an intraocular inflammation that typically occurs as part of immune reconstitution inflammatory syndrome (IRIS) in the eye. Typically, it affects human immunodeficiency virus (HIV)-infected patients with recognized or unrecognized cytomegalovirus (CMV) retinitis who are receiving highly active antiretroviral therapy (HAART). IRU is a common cause of new vision loss in these patients, and it manifests with a wide range of symptoms and an increased risk of inflammatory complications, such as macular edema. Recently, similar IRU-like responses have been observed in non-HIV individuals with immune reconstitution following immunosuppression of diverse etiologies, posing challenges in diagnosis and treatment. This review provides an updated overview of the current literature on the epidemiology, pathophysiology, biomarkers, clinical manifestations, diagnosis, differential diagnosis, and treatment strategies for IRU.
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Affiliation(s)
- Nuno Rodrigues Alves
- Department of Ophthalmology, Unidade Local de Saúde de São José, Centro Hospitalar Universitário Lisboa Central, Rua José António Serrano, 1150-199, Lisbon, Portugal.
| | - Catarina Barão
- Department of Ophthalmology, Unidade Local de Saúde de São José, Centro Hospitalar Universitário Lisboa Central, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Catarina Mota
- Department of Ophthalmology, Unidade Local de Saúde de São José, Centro Hospitalar Universitário Lisboa Central, Rua José António Serrano, 1150-199, Lisbon, Portugal
| | - Lívio Costa
- Department of Ophthalmology, Unidade Local de Saúde de São José, Centro Hospitalar Universitário Lisboa Central, Rua José António Serrano, 1150-199, Lisbon, Portugal
- NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rita Pinto Proença
- Department of Ophthalmology, Unidade Local de Saúde de São José, Centro Hospitalar Universitário Lisboa Central, Rua José António Serrano, 1150-199, Lisbon, Portugal
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Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, Todi SK, Mohan A, Hegde A, Jagiasi BG, Krishna B, Rodrigues C, Govil D, Pal D, Divatia JV, Sengar M, Gupta M, Desai M, Rungta N, Prayag PS, Bhattacharya PK, Samavedam S, Dixit SB, Sharma S, Bandopadhyay S, Kola VR, Deswal V, Mehta Y, Singh YP, Myatra SN. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024; 28:S104-S216. [PMID: 39234229 PMCID: PMC11369928 DOI: 10.5005/jp-journals-10071-24677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/20/2024] [Indexed: 09/06/2024] Open
Abstract
How to cite this article: Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, et al. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024;28(S2):S104-S216.
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Affiliation(s)
- Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Subhash K Todi
- Department of Critical Care, AMRI Hospital, Kolkata, West Bengal, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, New Delhi, India
| | - Ashit Hegde
- Department of Medicine & Critical Care, P D Hinduja National Hospital, Mumbai, India
| | - Bharat G Jagiasi
- Department of Critical Care, Kokilaben Dhirubhai Ambani Hospital, Navi Mumbai, Maharashtra, India
| | - Bhuvana Krishna
- Department of Critical Care Medicine, St John's Medical College and Hospital, Bengaluru, India
| | - Camila Rodrigues
- Department of Microbiology, P D Hinduja National Hospital, Mumbai, India
| | - Deepak Govil
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Divya Pal
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mukesh Desai
- Department of Immunology, Pediatric Hematology and Oncology Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Narendra Rungta
- Department of Critical Care & Anaesthesiology, Rajasthan Hospital, Jaipur, India
| | - Parikshit S Prayag
- Department of Transplant Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Pradip K Bhattacharya
- Department of Critical Care Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Srinivas Samavedam
- Department of Critical Care, Ramdev Rao Hospital, Hyderabad, Telangana, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Sudivya Sharma
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Susruta Bandopadhyay
- Department of Critical Care, AMRI Hospitals Salt Lake, Kolkata, West Bengal, India
| | - Venkat R Kola
- Department of Critical Care Medicine, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Vikas Deswal
- Consultant, Infectious Diseases, Medanta - The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesia, Medanta – The Medicity, GuruGram, Haryana, India
| | - Yogendra P Singh
- Department of Critical Care, Max Super Speciality Hospital, Patparganj, New Delhi, India
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Dupnik K, Rivera VR, Dorvil N, Duffus Y, Akbarnejad H, Gao Y, Liu J, Apollon A, Dumont E, Riviere C, Severe P, Lavoile K, Duran Mendicuti MA, Pierre S, Rouzier V, Walsh KF, Byrne AL, Joseph P, Cremieux PY, Pape JW, Koenig SP. Potential Utility of C-reactive Protein for Tuberculosis Risk Stratification Among Patients With Non-Meningitic Symptoms at HIV Diagnosis in Low- and Middle-income Countries. Open Forum Infect Dis 2024; 11:ofae356. [PMID: 39022393 PMCID: PMC11252845 DOI: 10.1093/ofid/ofae356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/27/2024] [Indexed: 07/20/2024] Open
Abstract
Background The World Health Organization recommends initiating same-day antiretroviral therapy (ART) while tuberculosis (TB) testing is under way for patients with non-meningitic symptoms at HIV diagnosis, though safety data are limited. C-reactive protein (CRP) testing may improve TB risk stratification in this population. Methods In this baseline analysis of 498 adults (>18 years) with TB symptoms at HIV diagnosis who were enrolled in a trial of rapid ART initiation in Haiti, we describe test characteristics of varying CRP thresholds in the diagnosis of TB. We also assessed predictors of high CRP as a continuous variable using generalized linear models. Results Eighty-seven (17.5%) participants were diagnosed with baseline TB. The median CRP was 33.0 mg/L (interquartile range: 5.1, 85.5) in those with TB, and 2.6 mg/L (interquartile range: 0.8, 11.7) in those without TB. As the CRP threshold increased from ≥1 mg/L to ≥10 mg/L, the positive predictive value for TB increased from 22.4% to 35.4% and negative predictive value decreased from 96.9% to 92.3%. With CRP thresholds varying from <1 to <10 mg/L, a range from 25.5% to 64.9% of the cohort would have been eligible for same-day ART and 0.8% to 5.0% would have untreated TB at ART initiation. Conclusions CRP concentrations can be used to improve TB risk stratification, facilitating same-day decisions about ART initiation. Depending on the CRP threshold, one-quarter to two-thirds of patients could be eligible for same-day ART, with a reduction of 3- to 20-fold in the proportion with untreated TB, compared with a strategy of same-day ART while awaiting TB test results.
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Affiliation(s)
- Kathryn Dupnik
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Vanessa R Rivera
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Nancy Dorvil
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Yanique Duffus
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | - Yipeng Gao
- The Analysis Group, Boston, Massachusetts, USA
| | - Jingyi Liu
- The Analysis Group, Boston, Massachusetts, USA
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Emelyne Dumont
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Cynthia Riviere
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Patrice Severe
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Kerlyne Lavoile
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Samuel Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- St. Vincent's Hospital and Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Kathleen F Walsh
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Anthony L Byrne
- St. Vincent's Hospital and Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Patrice Joseph
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Jean William Pape
- Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- St. Vincent's Hospital and Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Serena P Koenig
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Górecka A, Majewski S, Szymańska E, Walecka I. Skin and mucosal manifestations of immune reconstitution inflammatory syndrome in people living with HIV: a review. Int J Dermatol 2024; 63:852-857. [PMID: 38426349 DOI: 10.1111/ijd.17082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/15/2024] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
Opportunistic infections have significantly decreased in individuals living with human immunodeficiency virus and receiving antiretroviral therapy. However, in approximately 10%-25% of patients, severe skin reactions during immune reconstruction are constantly increasing. This may manifest as either an exacerbation of a chronic disease or the development of a new disorder, referred to as immune reconstitution inflammatory syndrome. This review focuses on the current knowledge regarding the dermatological symptoms of immune reconstitution inflammatory syndrome observed in recent years. These symptoms encompass various pathogens, neoplasms, and certain autoimmune diseases. In addition to the most common skin reactions, attention is directed towards conditions not previously described in any review, such as psoriasis.
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Affiliation(s)
- Aleksandra Górecka
- Department of Dermatology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
| | - Sławomir Majewski
- Department of Dermatology and Venereology, Medical University of Warsaw, Warsaw, Poland
| | - Elżbieta Szymańska
- Department of Dermatology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
- Department of Dermatology and Pediatric Dermatology, Centre of Postgraduate Medical Education in Warsaw, Warsaw, Poland
| | - Irena Walecka
- Department of Dermatology, National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
- Department of Dermatology and Pediatric Dermatology, Centre of Postgraduate Medical Education in Warsaw, Warsaw, Poland
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30
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Zuo Z, Zheng R, Li F, Xu A, Shi J. Coinfection of Cytomegalovirus, Pneumocystis jirovecii pneumonia, COVID-19, and Mycobacterium colombiense in an AIDS patient: A case report. Heliyon 2024; 10:e31729. [PMID: 38867990 PMCID: PMC11167289 DOI: 10.1016/j.heliyon.2024.e31729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024] Open
Abstract
We present an AIDS patient coinfected with Cytomegalovirus, Pneumocystis jirovecii pneumonia, nontuberculous mycobacteria, and COVID-19, who finally recovered from the coinfection. The 36-year-old man had two hospitalizations. In the first hospitalization, the patient was diagnosed with Cytomegalovirus, Pneumocystis jirovecii pneumonia, HIV, and COVID-19 quickly and accurately, and the corresponding treatment worked well. The second hospitalization can be divided into four stages: (1) Persistent fever period; (2) Persistent fever and Pulmonary Progression; (3) ICU period; and (4) Pneumothorax period. During the second hospitalization, the diagnosis of Mycobacterium colombiense was hard because the NGS, acid-fast bacilli, and culture of vomit, sputum, and bronchoalveolar lavage fluid were all negative. Still, we detected acid-fast bacilli in the blood mycobacterium culture. In conclusion, we report a severe pneumonia AIDS patient coinfected with Cytomegalovirus, Pneumocystis jirovecii pneumonia, COVID-19, and Mycobacterium colombiense who finally recovered from the disease. Nontuberculous mycobacteria infection is common in HIV patients, but bronchoalveolar lavage fluid NGS cannot identify nontuberculous mycobacteria in our report. Traditional blood culture was useful in detecting acid-fast bacilli in our study and then detecting the pathogens with NGS. Combining traditional microbial culture and emerging rapid NGS methods is more conducive to clinical diagnosis and treatment.
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Affiliation(s)
- Zhongbao Zuo
- Department of Clinical Laboratory, Hangzhou Xixi Hospital, 310023, Zhejiang, China
| | - Rongrong Zheng
- The Second Department of Infectious Diseases, Hangzhou Xixi Hospital, 310023, Zhejiang, China
| | - Feng Li
- The Second Department of Infectious Diseases, Hangzhou Xixi Hospital, 310023, Zhejiang, China
| | - Aifang Xu
- Department of Clinical Laboratory, Hangzhou Xixi Hospital, 310023, Zhejiang, China
| | - Jinchuan Shi
- The Second Department of Infectious Diseases, Hangzhou Xixi Hospital, 310023, Zhejiang, China
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Chang MH, Guo Y, Acbo A, Bao H, McSweeney T, Vo CA, Nori P. Antiretroviral Stewardship: Top 10 Questions Encountered by Stewardship Teams and Solutions to Optimize Therapy. Clin Ther 2024; 46:455-462. [PMID: 38704295 DOI: 10.1016/j.clinthera.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Infectious disease pharmacists and physicians overseeing antimicrobial stewardship programs possess expertise and often advanced certification in management of antiretrovirals to treat HIV. Stewardship programs are responsible for managing facility formularies and must stay up to date with the latest antiretrovirals, including once daily formulations and depot injectables. Furthermore, stewardship program members need to understand drug-interactions, short-, and long-term toxicities of these regimens, including dyslipidemia and cardiovascular effects. Patients receiving chronic antiretroviral therapy may present to the acute care, ambulatory care, and long-term care settings. Like other antimicrobials, audit-and-feedback, drug monitoring, and dose-optimization are often required to prevent antiretroviral associated medication errors and minimize resistance. METHODS A narrative review was conducted on antiretroviral stewardship, addressing common clinical questions encountered by stewardship teams and best practices to optimize antiretroviral therapy and reduce the risk for treatment interruptions, resistance, drug interactions, long term toxicities, and other adverse effects. FINDINGS People living with HIV are often hospitalized and treated by medical teams without formal HIV training. For this reason, these patients are at greater risk for medication errors during hospitalization and between transitions of care. Many opportunities are present for antiretroviral stewardship to mitigate these errors. Frequent updates to simplify HIV regimen, maintain select patients on fixed-dose combination tablets, and strategies to minimize drug interactions make it difficult for even the seasoned clinician to keep up regularly. IMPLICATIONS Despite the availability of free online HIV resources and progress made in HIV management, significant opportunities for antiretroviral stewardship remain. Implementing electronic order entry updates, formulary upgrades, and formal pharmacy renal dose adjustments to optimize antiretroviral therapy will help clinicians harness these opportunities. Dedicated time and expertise for antiretroviral stewardship as part of local antimicrobial stewardship programs are needed.
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Affiliation(s)
- Mei H Chang
- Department of Pharmacy, Montefiore Health System, Bronx, New York.
| | - Yi Guo
- Department of Pharmacy, Montefiore Health System, Bronx, New York
| | - Antoinette Acbo
- Department of Pharmacy, Montefiore Health System, Bronx, New York
| | - Hongkai Bao
- Department of Pharmacy, Montefiore Health System, Bronx, New York
| | | | - Christopher A Vo
- Division of Infectious Diseases, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Priya Nori
- Division of Infectious Diseases, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
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Richards GA, Zamparini J, Kalla I, Laher A, Murray LW, Shaddock EJ, Stacey S, Venter WF, Feldman C. Critical illness due to infection in people living with HIV. Lancet HIV 2024; 11:e406-e418. [PMID: 38816142 DOI: 10.1016/s2352-3018(24)00096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 06/01/2024]
Abstract
People living with HIV comprise a substantial number of the patients admitted to intensive care. This number varies according to geography, but all areas of the world are affected. In lower-income and middle-income countries, the majority of intensive care unit (ICU) admissions relate to infections, whereas in high-income countries, they often involve HIV-associated non-communicable diseases diagnoses. Management of infections potentially resulting in admission to the ICU in people living with HIV include sepsis, respiratory infections, COVID-19, cytomegalovirus infection, and CNS infections, both opportunistic and non-opportunistic. It is crucial to know which antiretroviral therapy (ART) is appropriate, when is the correct time to administer it, and to be aware of any safety concerns and potential drug interactions with ART. Although ART is necessary for controlling HIV infections, it can also cause difficulties relevant to the ICU such as immune reconstitution inflammatory syndrome, and issues associated with ART administration in patients with gastrointestinal dysfunction on mechanical ventilation. Managing infection in people with HIV in the ICU is complex, requiring collaboration from a multidisciplinary team knowledgeable in both the management of the specific infection and the use of ART. This team should include intensivists, infectious disease specialists, pharmacists, and microbiologists to ensure optimal outcomes for patients.
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Affiliation(s)
- Guy A Richards
- Department of Surgery, Division of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jarrod Zamparini
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ismail Kalla
- Department of Internal Medicine, Division of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdullah Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lyle W Murray
- Department of Internal Medicine, Division of Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erica J Shaddock
- Department of Internal Medicine, Division of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Stacey
- Department of Internal Medicine, Division of Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Wd Francois Venter
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Fu W, Deng ZW, Wang P, Zhu ZW, Pu Y, Xie ZB, Li YZ, Yu HY. A complex case study: coexistence of multi-drug-resistant pulmonary tuberculosis, HBV-related liver failure, and disseminated cryptococcal infection in an AIDS patient. BMC Infect Dis 2024; 24:533. [PMID: 38802753 PMCID: PMC11129448 DOI: 10.1186/s12879-024-09431-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 05/24/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection can cause liver failure, while individuals with Acquired Immunodeficiency Virus Disease (AIDS) are highly susceptible to various opportunistic infections, which can occur concurrently. The treatment process is further complicated by the potential occurrence of immune reconstitution inflammatory syndrome (IRIS), which presents significant challenges and contributes to elevated mortality rates. CASE PRESENTATION The 50-year-old male with a history of chronic hepatitis B and untreated human immunodeficiency virus (HIV) infection presented to the hospital with a mild cough and expectoration, revealing multi-drug resistant pulmonary tuberculosis (MDR-PTB), which was confirmed by XpertMTB/RIF PCR testing and tuberculosis culture of bronchoalveolar lavage fluid (BALF). The patient was treated with a regimen consisting of linezolid, moxifloxacin, cycloserine, pyrazinamide, and ethambutol for tuberculosis, as well as a combination of bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) for HBV and HIV viral suppression. After three months of treatment, the patient discontinued all medications, leading to hepatitis B virus reactivation and subsequent liver failure. During the subsequent treatment for AIDS, HBV, and drug-resistant tuberculosis, the patient developed disseminated cryptococcal disease. The patient's condition worsened during treatment with liposomal amphotericin B and fluconazole, which was ultimately attributed to IRIS. Fortunately, the patient achieved successful recovery after appropriate management. CONCLUSION Enhancing medical compliance is crucial for AIDS patients, particularly those co-infected with HBV, to prevent HBV reactivation and subsequent liver failure. Furthermore, conducting a comprehensive assessment of potential infections in patients before resuming antiviral therapy is essential to prevent the occurrence of IRIS. Early intervention plays a pivotal role in improving survival rates.
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Affiliation(s)
- Wei Fu
- Center for Infectious Diseases, Hunan University of Medicine General Hospital, Huaihua, Hunan, China
- Department of Tuberculosis, The First Affiliated Hospital of Xinxiang Medical University, XinXiang, Henan, China
| | - Zi Wei Deng
- Department of Clinical Pharmacy, Hunan University of Medicine General Hospital, Huaihua, Hunan, China
| | - Pei Wang
- Center for Infectious Diseases, Hunan University of Medicine General Hospital, Huaihua, Hunan, China
| | - Zhen Wang Zhu
- Center for Infectious Diseases, Hunan University of Medicine General Hospital, Huaihua, Hunan, China
| | - Ye Pu
- Center for Infectious Diseases, Hunan University of Medicine General Hospital, Huaihua, Hunan, China
| | - Zhi Bing Xie
- Center for Infectious Diseases, Hunan University of Medicine General Hospital, Huaihua, Hunan, China
| | - Yong Zhong Li
- Center for Infectious Diseases, Hunan University of Medicine General Hospital, Huaihua, Hunan, China
| | - Hong Ying Yu
- Center for Infectious Diseases, Hunan University of Medicine General Hospital, Huaihua, Hunan, China.
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Loghin II, Rusu ȘA, Vâţă A, Cobaschi M, Cecan I, Manciuc C, Dorobăţ CM. Antiretroviral Therapy Switch in HIV-Infected Adults from a Regional HIV/AIDS Center in NE Romania. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:854. [PMID: 38929471 PMCID: PMC11205825 DOI: 10.3390/medicina60060854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Antiretroviral therapy (ART) has revolutionized the management of HIV infection, transforming it from a once-debilitating disease to a chronic, manageable condition. However, challenges such as treatment resistance, medication side effects, and long-term tolerability persist, prompting the exploration of novel therapeutic approaches. We aimed to highlight the characteristics and related comorbidities of HIV/AIDS cases in which the antiretroviral therapy was modified. Material and Methods: A cross-sectional clinical investigation was conducted on adults diagnosed with HIV/AIDS who were hospitalized at the "St. Parascheva" Clinical Hospital of Infectious Diseases in Iasi in the Northeastern region of Romania. The timeframe under investigation was 1 January 2023 to 30 June 2023. Results: In the Northeastern part of Romania, from a total of 1692 patients in the active records, there were a total of 148 recorded cases of antiretroviral therapy switch in HIV-infected patients. The main reason for the ART switch was the simplification of the ART regimen (82 cases, 55.40%), viro-immunological failure (16 cases, 10.66%), other disturbances correlated to the ART regimen, dyslipidemia (34 cases 22.97%), depression (3 cases, 2.02%), suicide attempt (1 case, 0.67%), new situations, including the appearance of pregnancy (3 cases 2.02%), and tuberculosis (9 cases, 6.08%). ART before the switch was represented by protease inhibitors that accounted for 84 cases (56.75%) of the ART switch. Following the therapy switch, integrase inhibitor-based ART single-tablet regimens accounted for 43.91% (65 cases) of all changeovers, with non-nucleoside reverse transcriptase inhibitor regimens coming in second, in 63 cases, 42.66%. Conclusions: ART switch as an experimental therapy offers a promising approach to optimizing HIV treatment outcomes. By focusing on viral suppression and immune reconstitution, addressing treatment challenges, and exploring novel ARV agents, ART switch strategies aim to improve the overall health and well-being of individuals living with HIV.
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Affiliation(s)
- Isabela Ioana Loghin
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.I.L.); (C.M.)
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (I.C.); (C.M.D.)
| | - Șerban Alin Rusu
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (I.C.); (C.M.D.)
| | - Andrei Vâţă
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.I.L.); (C.M.)
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (I.C.); (C.M.D.)
| | - Mihaela Cobaschi
- Faculty of Medicine/Clinical II Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, 021105 Bucharest, Romania
| | - Ion Cecan
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (I.C.); (C.M.D.)
| | - Carmen Manciuc
- Department of Infectious Diseases, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.I.L.); (C.M.)
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (I.C.); (C.M.D.)
| | - Carmen Mihaela Dorobăţ
- Department of Infectious Diseases, “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania; (Ș.A.R.); (I.C.); (C.M.D.)
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Robert M, Mageau A, Gaudemer A, Thy M, Peiffer Smadja N, de Lastours V, De Broucker T, Papo T, Goulenok T, Sacré K. Incidence, risk factors and treatment of central nervous system immune reconstitution inflammatory syndrome in non-HIV patients with tuberculous meningitis: a multicentre observational study. Intern Med J 2024; 54:802-808. [PMID: 38064539 DOI: 10.1111/imj.16295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/15/2023] [Indexed: 05/18/2024]
Abstract
BACKGROUND Immune reconstitution inflammatory syndrome (IRIS) affecting the central nervous system (CNS) is associated with poor outcomes. AIMS To report on risk factors for CNS-IRIS following tuberculous meningitis (TBM) in HIV-negative patients. METHODS In this retrospective multicentre study, all HIV-negative adult patients admitted between 2003 and 2021 with microbiologically proven TBM were included. The primary outcome measure was IRIS onset over follow-up. Characteristics of patients who developed IRIS were described. Factors associated with IRIS were identified using a multivariable logistic regression procedure. RESULTS Fifty-six patients (33.0 (27.0-44.3) years, 39 (69.6%) men) with microbiologically proven TBM were studied. All patients received antituberculosis treatment and 48 (n = 48/56; 85.7%) steroids at TBM diagnosis. During a median follow-up of 18.0 (12.0-27.3) months, IRIS occurred in 28 (n = 28/56, 50.0%) patients, at a median time of 2.0 (1.0-3.0) months after antituberculosis treatment was started. IRIS involved the CNS in all but one case. Imaging revealed new (n = 23/28, 82.1%) and/or worsening (n = 21/28; 75.0%) of previously recognised lesions. Multivariable analysis showed that meningeal enhancement on brain magnetic resonance imaging (MRI) (odds ratio (OR): 15.3; 95% confidence interval (CI): (1.19-1193.5)) at TBM diagnosis and high blood albumin level (OR: 1.21; 95% CI: (1.02-1.60)) were associated with the occurrence of CNS-IRIS during follow-up. CONCLUSION CNS-IRIS following TBM in non-HIV patients appears frequent and severe. Meningeal enhancement on brain MRI at tuberculosis diagnosis is a risk factor for CNS-IRIS.
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Affiliation(s)
- Marie Robert
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Arthur Mageau
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Augustin Gaudemer
- Service de Radiologie, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Michael Thy
- Service de Maladies infectieuses, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Nathan Peiffer Smadja
- Service de Maladies infectieuses, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Victoire de Lastours
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Thomas Papo
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
- Centre de Recherche sur l'Inflammation, INSERM UMR1149, CNRS ERL8252, Faculté de Médecine site Bichat, Laboratoire d'Excellence, Inflamex, Université de Paris, Paris, France
| | - Tiphaine Goulenok
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Karim Sacré
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
- Centre de Recherche sur l'Inflammation, INSERM UMR1149, CNRS ERL8252, Faculté de Médecine site Bichat, Laboratoire d'Excellence, Inflamex, Université de Paris, Paris, France
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Pal D, Rupali P. Coccidioides immitis immune reconstitution inflammatory syndrome (IRIS) in advanced HIV - An evidence-based summary. IDCases 2024; 36:e01957. [PMID: 38699522 PMCID: PMC11063501 DOI: 10.1016/j.idcr.2024.e01957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/26/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024] Open
Affiliation(s)
- Dipankar Pal
- Correspondence to: Boral, Kalabagan, Kolkata 700154, India.
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamilnadu, India
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Lin N, Erdos T, Louie C, Desai R, Lin N, Ayzenberg G, Venketaraman V. The Role of Glutathione in the Management of Cell-Mediated Immune Responses in Individuals with HIV. Int J Mol Sci 2024; 25:2952. [PMID: 38474196 PMCID: PMC10932396 DOI: 10.3390/ijms25052952] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Human immunodeficiency virus (HIV) is a major cause of death worldwide. Without appropriate antiretroviral therapy, the infection can develop into acquired immunodeficiency syndrome (AIDS). AIDS leads to the dysregulation of cell-mediated immunity resulting in increased susceptibility to opportunistic infections and excessive amounts of inflammatory cytokines. HIV-positive individuals also demonstrate diminished glutathione (GSH) levels which allows for increased viral replication and increased pro-inflammatory cytokine release, further contributing to the high rates of mortality seen in patients with HIV. Adequate GSH supplementation has reduced inflammation and slowed the decline of CD4+ T cell counts in HIV-positive individuals. We aim to review the current literature regarding the role of GSH in cell-mediated immune responses in individuals with HIV- and AIDS-defining illnesses.
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Affiliation(s)
- Nicole Lin
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA (T.E.); (C.L.); (R.D.); (G.A.)
| | - Thomas Erdos
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA (T.E.); (C.L.); (R.D.); (G.A.)
| | - Carson Louie
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA (T.E.); (C.L.); (R.D.); (G.A.)
| | - Raina Desai
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA (T.E.); (C.L.); (R.D.); (G.A.)
| | - Naomi Lin
- Creighton University School of Medicine, Creighton University, Omaha, NE 68178, USA;
| | - Gregory Ayzenberg
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA (T.E.); (C.L.); (R.D.); (G.A.)
| | - Vishwanath Venketaraman
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA (T.E.); (C.L.); (R.D.); (G.A.)
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Abstract
HIV infection alters the skin microbiome and predisposes to a wide range of cutaneous infections, from atypical presentations of common skin infections to severe disseminated infections involving the skin that are AIDS-defining illnesses. Bacterial infection of the skin, most commonly caused by Staphylococcus aureus, occurs frequently and can result in bacteremia. Nontuberculous mycobacterial infections that are usually localized to the skin may disseminate, and guidance on the treatment of these infections is limited. Herpes simplex can be severe, and less common presentations such as herpetic sycosis and herpes vegetans have been reported. Severe herpes zoster, including disseminated infection, requires intravenous antiviral treatment. Viral warts can be particularly difficult to treat, and in atypical or treatment-resistant cases a biopsy should be considered. Superficial candidosis occurs very commonly in people living with HIV, and antifungal resistance is an increasing problem in non-albicans Candida species. Systemic infections carry a poor prognosis. In tropical settings the endemic mycoses including histoplasmosis are a problem for people living with HIV, and opportunistic infections can affect those with advanced HIV in all parts of the world. Most cutaneous infections can develop or worsen as a result of immune reconstitution in the weeks to months after starting antiretroviral therapy. Direct microscopic examination of clinical material can facilitate rapid diagnosis and treatment initiation, although culture is important to provide microbiological confirmation and guide treatment.
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Affiliation(s)
- David J Chandler
- Dermatology Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Stephen L Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Hospital for Tropical Diseases and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
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Qu J, Lv X. Cryptococcal meningitis in apparently immunocompetent patients. Crit Rev Microbiol 2024; 50:76-86. [PMID: 36562731 DOI: 10.1080/1040841x.2022.2159786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Cryptococcal meningitis (CM) is an invasive fungal disease that currently poses a threat to human health worldwide, with high morbidity and mortality, particularly in immunocompromised patients. Although CM mainly occurs in HIV-positive patients and other immunocompromised patients, it is also increasingly seen in seemingly immunocompetent hosts. The clinical characteristics of CM between immunocompromised and immunocompetent populations are different. However, few studies have focussed on CM in immunocompetent individuals. This review summarizes the clinical characteristics of apparently immunocompetent CM patients in terms of aetiology, immune pathogenesis, clinical presentation, laboratory data, imaging findings, treatment strategies and prognosis. It is of great significance to further understand the disease characteristics of CM, explore new treatment strategies and improve the prognosis of CM in immunocompetent individuals.
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Affiliation(s)
- Junyan Qu
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoju Lv
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, China
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Bangoura ST, Diallo BD, Diaby M, Camara A, Hounmenou CG, Magassouba AS, Kadio KJJO, Vanhems P, Touré A, Khanafer N. Predictors of Death in Rifampicin Resistant Tuberculosis Patients Treated with the Short Course in Conakry, Guinea. Am J Trop Med Hyg 2024; 110:117-122. [PMID: 37956449 PMCID: PMC10793011 DOI: 10.4269/ajtmh.23-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/17/2023] [Indexed: 11/15/2023] Open
Abstract
The emergence of rifampicin-resistant tuberculosis (RR-TB) is a major issue for TB control programs due to high risk of treatment failure and death. The objective of this study was to describe survival and to determine predictors of death in RR-TB patients treated with the short regimen (9-11 months) in the Conakry TB treatment centers. Sociodemographic, clinical, and survival data were collected prospectively between 2016 and 2021 on RR-TB patients in the Department of Pneumo-Phtisiology, the Carrière and the Tombolia TB centers. The Kaplan-Meier method was used to estimate the cumulative incidence of death of patients. The Cox regression model was used to identify the predictors independently associated with death. Of 869 patients, 164 (18.9%) patients died during treatment, 126 of them within 120 days of treatment initiation. The factors associated with death during treatment were as follows: patients treated in the Carrière TB center (adjusted hazard ratio [aHR] = 1.65; 95% CI: 1.06-2.59) and in the Department of Pneumo-Phtisiology (aHR = 3.26; 95% CI: 2.10-5.07), patients ≥ 55 years old (aHR = 4.80; 95% CI: 2.81-8.19), patients with no history of first-line TB treatment (aHR = 1.51; 95% CI: 1.05-2.16), and patients living with HIV (aHR = 2.81; 95% CI: 1.94-4.07). The results of this study can help the national TB control program to reconsider its therapeutic strategy to improve patient care in case of RR-TB. Large prospective clinical studies should be conducted to provide evidence of the impact of such factors like previous history of TB treatment and HIV infection on survival of RR-TB patients.
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Affiliation(s)
- Salifou Talassone Bangoura
- Centre de Recherche et de Formation en Infectiologie de Guinée, Gamal Abdel Nasser University, Conakry, Republic of Guinea
- Département de Santé Publique, Gamal Abdel Nasser University, Conakry, Republic of Guinea
- Département des Sciences Pharmaceutiques et Biologiques, Gamal Abdel Nasser University, Conakry, Republic of Guinea
| | - Boubacar Djelo Diallo
- Programme National de Lutte Antituberculeuse, Conakry, Republic of Guinea
- Service de Pneumo-Phtisiologie, Hôpital National Ignace Deen, Conakry, Republic of Guinea
| | - Maladho Diaby
- Centre de Recherche et de Formation en Infectiologie de Guinée, Gamal Abdel Nasser University, Conakry, Republic of Guinea
| | - Alioune Camara
- Centre de Recherche et de Formation en Infectiologie de Guinée, Gamal Abdel Nasser University, Conakry, Republic of Guinea
- Département de Santé Publique, Gamal Abdel Nasser University, Conakry, Republic of Guinea
| | - Castro Gbêmêmali Hounmenou
- Centre de Recherche et de Formation en Infectiologie de Guinée, Gamal Abdel Nasser University, Conakry, Republic of Guinea
| | | | - Kadio Jean-Jacques Olivier Kadio
- Centre de Recherche et de Formation en Infectiologie de Guinée, Gamal Abdel Nasser University, Conakry, Republic of Guinea
- Département de Santé Publique, Gamal Abdel Nasser University, Conakry, Republic of Guinea
- Département des Sciences Pharmaceutiques et Biologiques, Gamal Abdel Nasser University, Conakry, Republic of Guinea
| | - Philippe Vanhems
- Santé Publique, Epidémiologie et Ecologie Evolutive des Maladies Infectieuses, Centre international de recherche en infectiologie, INSERM-U1111-UCBL Lyon 1-ENS Lyon, France
- Service d’Hygiène, Épidémiologie, Infectiovigilance et Prévention, Edouard Herriot Hospital, Hospices Civils de Lyon, France
| | - Abdoulaye Touré
- Centre de Recherche et de Formation en Infectiologie de Guinée, Gamal Abdel Nasser University, Conakry, Republic of Guinea
- Département de Santé Publique, Gamal Abdel Nasser University, Conakry, Republic of Guinea
- Département des Sciences Pharmaceutiques et Biologiques, Gamal Abdel Nasser University, Conakry, Republic of Guinea
| | - Nagham Khanafer
- Santé Publique, Epidémiologie et Ecologie Evolutive des Maladies Infectieuses, Centre international de recherche en infectiologie, INSERM-U1111-UCBL Lyon 1-ENS Lyon, France
- Service d’Hygiène, Épidémiologie, Infectiovigilance et Prévention, Edouard Herriot Hospital, Hospices Civils de Lyon, France
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Wongkittipong P, Kiertiburanakul S. Incidence and Predicting Factors of Opportunistic Infections after Antiretroviral Therapy Initiation among Treatment-naïve Patients with HIV Infection: A Retrospective Cohort Study in A Tertiary Care Hospital. J Int Assoc Provid AIDS Care 2024; 23:23259582241241167. [PMID: 38592111 PMCID: PMC11005498 DOI: 10.1177/23259582241241167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/31/2023] [Accepted: 03/02/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES To determine the incidence of opportunistic infections (OIs) and the predictive factors for the development of OIs after antiretroviral therapy (ART) initiation among treatment-naïve patients with HIV infection. RESULTS Of 401 HIV-infected patients, 38 (9.5%) HIV-infected patients developed OIs after initiating ART, with an incidence rate of 25.6/1000 person-years. The median time (IQR) from ART initiation to OI occurrence was 26.5 (14-73) days. In multivariate Cox proportional hazard regression, body mass index ≤18.5 kg/m2 (adjusted hazard ratio [aHR] 2.28, 95% confidence interval [CI] 1.18-4.42, P = .015), symptoms at presentation (aHR 13.59, 95% CI 3.24-56.9, P < .001), serum glutamate-pyruvate transaminase >55 U/L (aHR 2.09, 95% CI 1.06-4.15, P = .035), and initiation of a dolutegravir-based regimen (aHR 4.39, 95% CI 1.54-12.48, P = .006) were significantly associated with OIs after ART initiation. CONCLUSION OIs after ART initiation are common. Malnutrition, symptomatic presentation, abnormal liver enzymes, and DTG-based regimens are predictors of OI occurrence after ART initiation. Physicians must monitor and appropriately treat OIs after ART initiation.
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Affiliation(s)
- Prapon Wongkittipong
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Camici M, Gagliardini R, Lanini S, Del Duca G, Mondi A, Ottou S, Plazzi MM, De Zottis F, Pinnetti C, Vergori A, Grilli E, Mastrorosa I, Mazzotta V, Paulicelli J, Bellagamba R, Cimini E, Tartaglia E, Notari S, Tempestilli M, Cicalini S, Amendola A, Abbate I, Forbici F, Fabeni L, Girardi E, Vaia F, Maggi F, Antinori A. Rapid ART initiation with bictegravir/emtricitabine/tenofovir alafenamide in individuals presenting with advanced HIV disease (Rainbow study). Int J Antimicrob Agents 2024; 63:107049. [PMID: 38056572 DOI: 10.1016/j.ijantimicag.2023.107049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND A rapid ART initiation approach can be beneficial in people with advanced HIV disease, in consideration of their high morbidity and mortality. The aim of our study was to evaluate the feasibility, efficacy and safety of rapid ART start with BIC/FTC/TAF in this setting. METHODS Pilot, single-centre, single-arm, prospective, phase IV clinical trial conducted in a tertiary Italian hospital. Thirty ART-naïve people presenting with advanced HIV-1 diagnosis (defined as the presence of an AIDS-defining event and/or CD4 cell count <200 µL), were enrolled. Main exclusion criteria were active tuberculosis, cryptococcosis and pregnant/breastfeeding women. BIC/FTC/TAF was started within 7 days from HIV diagnosis. The primary endpoint was clinical or virologic failure (VF). Immunological parameters, safety, feasibility, neurocognitive performances and patient-reported outcomes were assessed as well. RESULTS Over the study period, 40 (34%) of 116 patients diagnosed with HIV infection at INMI Spallanzani had advanced disease, of whom 30 (26%) were enrolled. The proportion of participants with HIV-RNA <50 cp/mL was 9/30 (30%) at week (w) 4, 19/30 (63%) at w12, 24/30 (80%) at w24, 23/30 (77%) at w36 and 27/30 (90%) at w48. Two unconfirmed VF occurred. No ART discontinuation due to toxicity or VF was observed. No ART modification was performed based on the review of genotype and no mutations for the study drugs were detected. Mean CD4 cells count changed by 133 cells/μL at BL to 309 cells/μL at w 48 and 83% of participants had a CD4 > 200 cells/µL at w 48. Two participants developed IRIS and one was diagnosed with disseminated TB and needed an ART switch. INTERPRETATIONS Our results support the feasibility, efficacy and safety of BIC/FTC/TAF as a rapid ART strategy in patients with advanced HIV disease.
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Affiliation(s)
- Marta Camici
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy.
| | - Roberta Gagliardini
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Simone Lanini
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giulia Del Duca
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Mondi
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Sandrine Ottou
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria M Plazzi
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federico De Zottis
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmela Pinnetti
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Vergori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisabetta Grilli
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ilaria Mastrorosa
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Valentina Mazzotta
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Jessica Paulicelli
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Rita Bellagamba
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Cimini
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Eleonora Tartaglia
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Notari
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Massimo Tempestilli
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Cicalini
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra Amendola
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Isabella Abbate
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federica Forbici
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Lavinia Fabeni
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Francesco Vaia
- General Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Kalita J, Shukla R, Pandey PC, Singh V, Haldar R, Misra UK. mRNA profiling of cytokines to understand paradoxical response in HIV-uninfected tuberculous meningitis. Tuberculosis (Edinb) 2024; 144:102463. [PMID: 38101267 DOI: 10.1016/j.tube.2023.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
Paradoxical reaction (PR) in tuberculous meningitis (TBM) is a major management issue. We report mRNA profiling of cytokines to understand PR in HIV-uninfected TBM patients. 72 patients with TBM were included, and their clinical, MRI, and mRNA profiling of tumor necrosis factor (TNF) α, interleukin (IL) 6, IL10 and interferon (IFN) γ genes in the peripheral blood mononuclear cells were done at admission and 6 weeks of antitubercular treatment. Cytokine profiling was done using reverse transcriptase polymerase chain reaction. PR was defined if repeat MRI at 6 weeks revealed new or increase in exudates, tuberculoma, hydrocephalus or infarctions. Outcome was defined at 6 months using modified Rankin Scale (mRS), and categorized as death, poor and good. 44 (61.1 %) patients had PR, and 28 (38.9 %) had paradoxical tuberculoma (PT). The expression of IL6 and TNFα genes were higher in PR and PT groups. Stage of meningitis and hydrocephalus at admission predicted PR. Patients with PR and PT had more frequently poor outcome. About three-fifth HIV-uninfected TBM patients have PR and two-fifth have PT. Paradoxical reaction is associated with higher expression of IL6 and TNFα. Patients with severe meningitis with hydrocephalus develop PR more frequently.
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Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India.
| | - Ruchi Shukla
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India
| | - Prakash C Pandey
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India
| | - Vivek Singh
- Department of Radio diagnosis Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India
| | - Rudrashish Haldar
- Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India
| | - Usha K Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, Uttar Pradesh, India
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Rajsic S, Breitkopf R, Kojic D, Bukumiric Z, Treml B. Extracorporeal Life Support for Patients With Newly Diagnosed HIV and Acute Respiratory Distress Syndrome: A Systematic Review and Analysis of Individual Patient Data. ASAIO J 2023; 69:e513-e519. [PMID: 37738393 DOI: 10.1097/mat.0000000000002047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) may improve survival in patients with severe acute respiratory distress syndrome (ARDS). However, presence of immunosuppression is a relative contraindication for ECMO, which is withheld in HIV patients. We performed a systematic review to investigate the outcome of newly diagnosed HIV patients with ARDS receiving ECMO support. Our search yielded 288 publications, with 22 studies finally included. Initial presentation included fever, respiratory distress, and cough. Severe immunodeficiency was confirmed in most patients. Deceased patients had a higher viral load, a lower Horovitz index, and antiretroviral therapy utilized before ECMO. Moreover, ECMO duration was longer ( p = 0.0134), and all deceased suffered from sepsis ( p = 0.0191). Finally, despite the development of therapeutic options for HIV patients, ECMO remains a relative contraindication. We found that ECMO may successfully bridge the time for pulmonary recovery in 93% of patients, with a very good outcome. Using ECMO, the time for antimicrobial therapy, lung-protective ventilation, and immune system restitution may be gained. Further studies clarifying the role of ECMO in HIV are crucial and until these data are available, ECMO might be appropriate in immunocompromised patients. This holds especially true in newly diagnosed HIV patients, who are usually young, without comorbidities, with a good rehabilitation potential.
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Affiliation(s)
- Sasa Rajsic
- From the Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Robert Breitkopf
- From the Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Dejan Kojic
- Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
| | - Zoran Bukumiric
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Benedikt Treml
- From the Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
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Yasen D, Liu C, Mei X, Zhou H, Tang X, Chen X. Mycobacterium haemophilum infection with cutaneous involvement: two case reports and an updated literature review: Mycobacterium haemophilum skin infection. J Dtsch Dermatol Ges 2023; 21:1291-1305. [PMID: 37679966 DOI: 10.1111/ddg.15163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/28/2023] [Indexed: 09/09/2023]
Abstract
Mycobacterium haemophilum (MH) is a slow-growing, non-tuberculous Mycobacterium that most commonly causes infections in immunocompromised patients. The skin is the most prevalent site of infection and can be an isolated presentation or part of a disseminated disease. Herein, we reported a case of isolated MH infection of the hand and a case of disseminated MH infection with multiple skin lesions. In addition, other MH cases with cutaneous involvement over the last 10 years, from 2011-2022, were reviewed and analyzed. Among the 79 included cases, the common skin findings in MH infections included nodules, ulcers, abscesses, swelling, and pustules. Middle-aged patients with iatrogenic immunosuppression from glucocorticoids, mycophenolate mofetil, cyclosporine, and cyclophosphamide are the most susceptible to MH infection, with a higher risk of dissemination to internal organs. Disseminated MH infections commonly present as tenosynovitis, arthritis/arthralgia, or osteomyelitis. There is a lack of strong evidence for treatment; however, triple therapy of quinolone, macrolides, and rifampicin is most often used in clinical practice. The overall prognosis is good. The presence of iatrogenic immunocompromised diseases, lesions involving the proximal limbs, and dissemination of MH infections are associated with worse clinical outcomes.
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Affiliation(s)
- Dilidaer Yasen
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chaocheng Liu
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Xingxing Mei
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui Zhou
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuhua Tang
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaohong Chen
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Yasen D, Liu C, Mei X, Zhou H, Tang X, Chen X. Hautbeteiligung bei Infektionen mit Mycobacterium haemophilum: Zwei Fallberichte und eine aktualisierte Literaturübersicht: Mycobacterium haemophilum infection with cutaneous involvement: Two case reports and an updated literature review. J Dtsch Dermatol Ges 2023; 21:1291-1307. [PMID: 37946643 DOI: 10.1111/ddg.15163_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/28/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungMycobacterium haemophilum (MH) ist ein langsam wachsendes, nicht‐tuberkulöses Mykobakterium. Infektionen treten am häufigsten bei Patienten mit beeinträchtigtem Immunsystem auf; sie manifestieren sich meist an der Haut und kommen isoliert oder bei disseminierten Infektionen vor. Wir berichten hier über einen Fall mit isolierter MH‐Infektion an der Hand sowie über einen weiteren Fall von disseminierter MH‐Infektion mit multiplen Hautläsionen. Zusätzlich haben wir weitere Fallberichte über MH‐Infektionen mit kutaner Beteiligung aus den letzten zehn Jahren (2011–2022) ausgewertet. Die am häufigsten beobachteten Hautmanifestationen der insgesamt 79 Fälle waren Knötchen, Ulzera, Abszesse, Schwellungen und Pusteln. Patienten mittleren Alters mit iatrogener Immunsuppression durch Glucocorticoide, Mycophenolat‐Mofetil, Ciclosporin und Cyclophosphamid scheinen besonders anfällig für MH‐Infektionen zu sein und haben auch ein höheres Risiko für eine Dissemination in die inneren Organe. Disseminierte MH‐Infektionen manifestieren sich gewöhnlich als Tenosynovitis, Arthritis/Arthralgie oder Osteomyelitis. Derzeit gibt es keine starke Evidenz für bestimmte Therapeutika; in der Praxis wird am häufigsten eine Dreifachkombination aus Chinolon, Makroliden und Rifampicin eingesetzt. Die Prognose ist allgemein gut. Iatrogene Immunsuppression, Läsionen im proximalen Bereich der Extremitäten sowie disseminierte Manifestation sind mit schlechteren klinischen Verläufen assoziiert.
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Affiliation(s)
- Dilidaer Yasen
- Abteilung Dermatologie, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chaocheng Liu
- Abteilung Dermatologie und dermatologische Wissenschaft, University of British Columbia, Vancouver, BC, Kanada
| | - Xingxing Mei
- Abteilung Dermatologie, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hui Zhou
- Abteilung Dermatologie, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuhua Tang
- Abteilung Dermatologie, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaohong Chen
- Abteilung Dermatologie, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Song X, Duan R, Duan L, Wei L. Current knowledge of the immune reconstitution inflammatory syndrome in Whipple disease: a review. Front Immunol 2023; 14:1265414. [PMID: 37901208 PMCID: PMC10611461 DOI: 10.3389/fimmu.2023.1265414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) is characterized by exaggerated and dysregulated inflammatory responses that occur as a result of reconstitution of adaptive or innate immunity. A wide range of microorganisms have been found to be associated with IRIS, such as human immunodeficiency virus (HIV), Mycobacterium and actinobacteria. Whipple disease (WD) is an infectious disorder caused by the Gram-positive bacterium Tropheryma whipplei (T. whipplei) and IRIS also serves as a complication during its treament. Although many of these pathological mechanisms are shared with related inflammatory disorders, IRIS in WD exhibits distinct features and is poorly described in the medical literature. Novel investigations of the intestinal mucosal immune system have provided new insights into the pathogenesis of IRIS, elucidating the interplay between systemic and local immune responses. These insights may be used to identify monitoring tools for disease prevention and to develop treatment strategies. Therefore, this review synthesizes these new concepts in WD IRIS to approach the feasibility of manipulating host immunity and immune reconstitution of inflammatory syndromes from a newer, more comprehensive perspective and study hypothetical options for the management of WD IRIS.
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Affiliation(s)
| | | | | | - Lijuan Wei
- Department of Gastroenterology and Digestive Endoscopy Center, The Second Hospital of Jilin University, Chang Chun, Jilin, China
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48
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Yuen YS, Holder GE, Lingam G, Shen TYT. Diffuse retinal dysfunction following immune reconstitution uveitis in patients with prior cytomegalovirus retinitis: a novel observation. Doc Ophthalmol 2023; 147:139-145. [PMID: 37639171 DOI: 10.1007/s10633-023-09947-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To report continuing diffuse retinal dysfunction following resolution of immune reconstitution uveitis (IRU) in patients with cytomegalovirus retinitis (CMVR). METHODS Retrospective case series describing two patients with IRU following CMVR who underwent serial fundus photography and macular optical coherence tomography. One patient had serial electrophysiology. RESULTS Both patients had CMVR successfully treated with antiviral medication. The affected eyes later developed IRU that resolved with steroids. However, following resolution, chronic retinal damage was evidenced by ellipsoid line loss in one case and gradual optic disc cupping in the other. Electrophysiology in both cases revealed generalized retinal dysfunction worse in the eye with more severe IRU and demonstrated objectively the efficacy of treatment intervention in the patient with serial recordings. CONCLUSIONS Patients with IRU following CMV retinitis may have continuing diffuse retinal dysfunction despite apparent recovery and normal visual acuity. An aggressive approach to inflammation control may be warranted in such patients.
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Affiliation(s)
- Yew Sen Yuen
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
| | - Graham E Holder
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- UCL Institute of Ophthalmology, London, UK
| | - Gopal Lingam
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
| | - Tina Yu Ting Shen
- Department of Ophthalmology, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore
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Santana MN, Ferrari R, Macedo AC, Marcusso RMN, Fernandes RDA, Vidal JE. Acquired immunodeficiency syndrome-related progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome: prevalence, main characteristics, and outcomes in a Brazilian center. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:883-890. [PMID: 37899047 PMCID: PMC10631851 DOI: 10.1055/s-0043-1772831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/07/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) - immune reconstitution inflammatory syndrome (IRIS) in people living with HIV/AIDS (PLWHA) has been rarely described in low- and middle-income countries. OBJECTIVE To describe the prevalence of PML-IRIS among PLWHA with PML and its main features in a tertiary hospital in Brazil. METHODS We performed a retrospective cohort study. We included PLWHA with PML-IRIS patients admitted at Instituto de Infectologia Emílio Ribas, São Paulo, Brazil, between 2011 and 2021. We retrieved information on neurological manifestations, neuroimaging findings, treatments, and outcomes. RESULTS We identified 11 (11.8%) PML-IRIS cases among 93 patients with definite PML. Eight (73%) cases were men and had a median (IQR) age of 41 (27-50) years. Seven (63.6%) patients developed unmasking PML-IRIS and 4 (36.4%) had paradoxical PML-IRIS. The median (IQR) time from initiation of combined antiretroviral therapy (cART) to IRIS diagnosis was 49 (30-70) days. Ten (90.9%) patients received corticosteroids. There were 4 (36%) in-hospital deaths and 3 were associated with hospital-acquired pneumonia. Among the 7 (64%) patients who survived, 5 (71.5%) had sequelae at discharge. One year after the PML-IRIS diagnosis, 6 (54.5%) patients were alive. CONCLUSION The prevalence of PML-IRIS was 11.8%. Most patients had unmasking PML-IRIS. In-hospital mortality and morbidity were high. One-year survival was similar to that described in some high-income countries.
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Affiliation(s)
| | - Raphaela Ferrari
- Instituto de Infectologia Emílio Ribas, Departamento de Infectologia, São Paulo SP, Brazil.
| | - Arthur Cassa Macedo
- McGill University, Department of Neurology and Neurosurgery, Montreal QC, Canada.
| | | | | | - José Ernesto Vidal
- Instituto de Infectologia Emílio Ribas, Departamento de Neurologia, São Paulo SP, Brazil.
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo SP, Brazil.
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Investigação Médica (LIM 49), São Paulo SP, Brazil.
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50
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Min-ChunYeh, Chuang HC, Weng SF, Hsu CH, Huang CL, Lin YP, Lin YY, Hsieh YS. Newly diagnosed type 1 diabetes mellitus in a human immunodeficiency virus-infected patient with antiretroviral therapy-induced immune reconstitution inflammatory syndrome: a case report. BMC Infect Dis 2023; 23:619. [PMID: 37730544 PMCID: PMC10512543 DOI: 10.1186/s12879-023-08605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Diabetes that develops in human immunodeficiency virus (HIV)-infected patients who receive antiretroviral therapy (ART) is usually type 2 diabetes mellitus (T2DM); however, autoimmune diabetes, such as type 1 diabetes mellitus (T1DM) can also develop in this population. After treatment with ART, patients might experience clinical deterioration following an increase in the CD4 cell count, which is termed immune reconstitution inflammatory syndrome (IRIS). Here, we describe an HIV-infected patient on ART who developed T1DMat due to IRIS, highlighting the clinical complexity in diagnosis and treatment. CASE PRESENTATION A 36-year-old man infected with HIV had a nadir CD4 cell count of 15.53/μL before medication, which increased to 429.09/μL after 9 months of regular ART. The fasting serum glucose at 9 months was between 96 mg/dL and 117 mg/dL. After 11 months of ART, the patient was admitted to hospital for diabetic ketoacidosis (DKA) and Graves' disease (GD). Noninsulin antidiabetics (NIADs) were prescribed following the resolution of DKA. However, poor glycemic control was noted despite well-titrated NIADs. Further investigation demonstrated poor pancreatic beta cell function and elevated anti-glutamic acid decarboxylase (anti-GAD) and anti-tyrosine phosphatase-like insulinoma antigen 2 (anti-IA2) titers. According to the results, he was diagnosed with T1DM and received multiple daily injections(MDI) of insulin. The regimen of MDI was insulin degludec as basal insulin and insulin aspart as prandial insulin. After MDI therapy, his glycemic control was improved. CONCLUSION In this case, T1DM was ascribed to IRIS. Although this phenomenon has been demonstrated in previous case reports, further study is necessary to realize the mechanism of this association. Therefore, we emphasize that when HIV-infected patients on ART experience an unstable blood glucose level and abnormal thyroid function, physicians should consider T1DM and GD associated with ART-induced IRIS to reduce the subsequent complications and more serious endocrine dysfunction.
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Affiliation(s)
- Min-ChunYeh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Han-Chuan Chuang
- Division of Infection Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chung-Huei Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Chen-Ling Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yu-Pei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yan-Yu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Yu-Shan Hsieh
- School of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Mingde Rd., Beitou Dist, Taipei City, 112303 Taiwan
- Department of Research, Taipei Medical University Hospital, Taipei City, 11031 Taiwan
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