Characterizing Symptoms and Identifying Biomarkers of Long COVID in People With and Without HIV: Protocol for a Remotely Conducted Prospective Observational Cohort Study

BACKGROUND

Living with HIV is a risk factor for severe acute COVID-19, but it is unknown whether it is a risk factor for long COVID.

OBJECTIVE

This study aims to characterize symptoms, sequelae, and cognition formally and prospectively 12 months following SARS-CoV-2 infection in people living with HIV compared with people without HIV. People with no history of SARS-CoV-2 infection, both with and without HIV, are enrolled as controls. The study also aims to identify blood-based biomarkers or patterns of immune dysregulation associated with long COVID.

METHODS

This prospective observational cohort study enrolled participants into 1 of the following 4 study arms: people living with HIV who had SARS-CoV-2 infection for the first time <4 weeks before enrollment (HIV+COVID+ arm), people without HIV who had SARS-CoV-2 infection for the first time within 4 weeks of enrollment (HIV-COVID+ arm), people living with HIV who believed they never had SARS-CoV-2 infection (HIV+COVID- arm), and people without HIV who believed they never had SARS-CoV-2 infection (HIV-COVID- arm). At enrollment, participants in the COVID+ arms recalled their symptoms, mental health status, and quality of life in the month before having SARS-CoV-2 infection via a comprehensive survey administered by telephone or on the web. All participants completed the same comprehensive survey 1, 2, 4, 6, and 12 months after post-acute COVID-19 symptom onset or diagnosis, if asymptomatic, (COVID+ arms) or after enrollment (COVID- arms) on the web or by telephone. In total, 11 cognitive assessments were administered by telephone at 1 and 4 months after symptom onset (COVID+ arms) or after enrollment (COVID- arms). A mobile phlebotomist met the participants at a location of their choice for height and weight measurements, orthostatic vital signs, and a blood draw. Participants in the COVID+ arms donated blood 1 and 4 months after COVID-19, and participants in the COVID- arms donated blood once or none. Blood was then shipped overnight to the receiving study laboratory, processed, and stored.

RESULTS

This project was funded in early 2021, and recruitment began in June 2021. Data analyses will be completed by summer 2023. As of February 2023, a total of 387 participants were enrolled in this study, with 345 participants having completed enrollment or baseline surveys together with at least one other completed study event. The 345 participants includes 76 (22%) HIV+COVID+, 121 (35.1%) HIV-COVID+, 78 (22.6%) HIV+COVID-, and 70 (20.3%) HIV-COVID- participants.

CONCLUSIONS

This study will provide longitudinal data to characterize COVID-19 recovery over 12 months in people living with and without HIV. Additionally, this study will determine whether biomarkers or patterns of immune dsyregulation associate with decreased cognitive function or symptoms of long COVID.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47079.

Interruptions in Mental Health Care, Cannabis Use, Depression, and Anxiety during the COVID-19 Pandemic: Findings from a Cohort of HIV-Positive and HIV-Negative MSM in Los Angeles, California

The objective was to examine the impact of the COVID-19 pandemic on mental health care, cannabis use, and behaviors that increase the risk of STIs among men living with or at high risk for HIV. Data were from mSTUDY - a cohort of men who have sex with men in Los Angeles, California. Participants who were 18 to 45 years and a half were HIV-positive. mSTUDY started in 2014, and at baseline and semiannual visits, information was collected on substance use, mental health, and sexual behaviors. We analyzed data from 737 study visits from March 2020 through August 2021. Compared to visits prior to the COVID-19 pandemic, there were significant increases in depressive symptomatology (CES-D ≥ 16) and anxiety (GAD-7 ≥ 10). These increases were highest immediately following the start of the pandemic and reverted to pre-pandemic levels within 17 months. Interruptions in mental health care were associated with higher substance use (especially cannabis) for managing anxiety/depression related to the pandemic (50% vs. 31%; p-value < .01). Cannabis use for managing pandemic-related anxiety/depression was higher among those reporting changes in sexual activity (53% vs. 36%; p-value = 0.01) and was independently associated with having more than one sex partner in the prior 2 weeks (adjusted OR = 1.5; 95% CI 1.0-2.4). Our findings indicate increases in substance use, in particular cannabis, linked directly to experiences resulting from the COVID-19 pandemic and the associated interruptions in mental health care. Strategies that deliver services without direct client contact are essential for populations at high risk for negative sexual and mental health outcomes.

Lubricants and rectal douching: associations with rectal gonorrhea, chlamydia, and/or syphilis infection among men who have sex with men

Despite widespread prevalence of lubricant use and rectal douching for receptive anal intercourse (RAI) among men who have sex with men (MSM), research evaluating the association of these behaviors with sexually transmitted infections (STIs) is limited. This is an observational analysis of a longitudinal cohort of predominantly Black/Latino MSM in Los Angeles. Every six months from August 2014 to January 2018, participants received STI screening and surveys evaluating lubricant use, douching, substance use, and sexual risk behaviors. General estimating equations evaluated the association between consistent lubricant use and douching for RAI with positive rectal Neisseria gonorrhoeae, Chlamydia trachomatis, and/or syphilis (positive STI). Among 313 participants across 552 study visits, 16.5% (91/552) had positive STI. Consistent lubricant use was reported in 52.7% (243/552) and rectal douching in 57.6% (318/552) of study visits. Consistent lubricant use was associated with STI diagnosis (adjusted OR [AOR] 1.81; 95% CI 1.11-2.96; p = 0.018). Each episode of rectal douching before RAI was associated with 2% increased odds of positive STI (AOR 1.02; 95% CI 1.00-1.04; p = 0.041). Among this cohort of HIV-positive and high-risk HIV-negative MSM, lubricant use and douching was common and independently associated with an STI, suggesting the utility of prevention messaging around barrier methods/condoms for sexual encounters involving douching/lubricant use.

An apparent excess of operative site infections: analyses to evaluate false-positive diagnoses

OBJECTIVE

To investigate an apparent excess of operative site infections (OSI) reported according to doctor's diagnosis (presumptive OSI) by applying objective criteria for classification (documented OSI). To examine potential consequences of habitual overdiagnosis of OSI.

DESIGN

A case-control design was used to examine the clinical course of 18 case patients (12 presumptive OSI, six documented OSI) and 18 matched controls. Comparisons also were made between presumptive and documented OSI patients.

SETTING

A nonteaching community hospital.

PATIENTS

Thirty-six patients having laminectomies done by the same surgeon.

INTERVENTION

Implementation of objective criteria for diagnosis of confirmed OSI and reclassification of presumptive OSI patients.

RESULTS

Postoperatively, the frequency of specific adverse events within the operative site (including postoperative hematoma or bleeding; wound necrosis, dehiscence, or sinus tract; and dural tear) was 83% for documented OSI patients, contrasted with 16.7% for presumptive OSI patients (P < .01) and controls (P = .007). Median days of inpatient stay were 27 for documented OSI, contrasted with 9.5 for presumptive OSI (P = .01) and 7 for controls (P < .001).

CONCLUSION

Documented OSI patients were found to have significantly more adverse findings and longer lengths of stay than presumptive OSI patients or controls. The similarity of findings for presumptive OSI patients and controls suggests that the apparent excess frequency of OSI was caused by incorrect diagnosis. Whereas doctor's diagnosis may be useful as an initial screen for OSI, use of objective criteria for confirming OSI may avert the consequences of overdiagnosis including excessive length of stay and unnecessary therapy, which lead to elevated healthcare costs and threaten a physician's practice.

[Indication for chemoembolization of liver tumors. An interdisciplinary concept and initial results]

We present a new concept after Schultheis which is based on the results of experimental studies on cell cultures. Local chemoembolization in liver tumours including liver metastases is usually performed via the angiographic route. Embolisation of the most peripheral branches of the hepatic artery prevents early formation of collateral vessels. The method also comprises the additional infusion of cytostatic agents via the portal vein. The procedure is usually repeated after an interval of about four weeks. In this paper we will describe our method in liver metastases and present the preliminary results obtained from 19 patients treated to date.

Peripheral percutaneous transluminal laser angioplasty in humans: in vitro investigations and clinical results with a novel laser catheter system

Percutaneous transluminal laser angioplasty has become an accepted method of treatment of peripheral arterial occlusive disease. To minimize the risk of arterial wall perforation during laser angioplasty, a novel laser catheter system was developed. In 113 obliterated postmortem human arteries the perforation rate was 0.9%. The mean degree of stenosis was reduced from 89 +/- 9% before, to 53 +/- 11% after laser irradiation. Clinical Nd:YAG laser angioplasty was performed in 19 patients suffering from peripheral arterial occlusive disease. The Fontaine stage improved in 16 patients; in no case did it deteriorate. The mean degree of stenosis was reduced by laser angioplasty from 91 +/- 12% to 31 +/- 19%. A further reduction down to 13 +/- 18% was achieved by subsequent percutaneous transluminal balloon angioplasty. The systolic Doppler ankle-arm pressure gradient was improved from 0.58 +/- 0.26 to 0.89 +/- 0.25. In 7 patients microembolisms were detectable on the final angiogram. There was no acute reocclusion and no perforation. Within a follow-up period of 12 months, four restenoses were diagnosed by digital subtraction angiography. On average, the Doppler index was 0.75 +/- 0.32.

[Results of percutaneous transluminal angioplasty]

Percutaneous transluminal angioplasty (PTA) can be subdivided into three epochs: 1. from its inception by Dotter and Judkins up to the first coronary artery stenosis dilatation with the Grüntzig balloon catheter system; 2. from the introduction of coronary stenosis dilatation by Grüntzig up to its unequivocal acceptance; 3. the period of influence of low-risk coronary dilatation on peripheral angioplasty and the search for techniques to compliment or obviate the need for balloon dilatation. The Grüntzig double-lumen balloon catheter system contributed to the lower rate of complications and higher success rate. The clinical acceptance appeared greater for the coronary arteries since, in contrast to the peripheral vascular system, the indication for treatment is established by the physician performing the dilatation. PTA implies percutaneous puncture of a vessel with Seldinger technique and introduction of devices such as guidewires, Dotter or Grüntzig catheters among others, catheters with fiberglass for laser conduction and instruments for fractionating, drilling and cutting. The goal of PTA is to completely or partially eliminate, without surgery, intraluminal vascular narrowing in the presence of peripheral arterial disease in stage II, III or IV. Prerequisite to the use of PTA are: 1. adequate fluoroscopic and angiographic facilities; 2. adequate instrumentation; 3. experience with at least 200 procedures; 4. knowledge of the pathophysiology and adjunctive treatment; 5. knowledge of the treatment of complications; 6. cooperation with a vascular surgery service. A number of factors may influence the results of treatment. Adjunctive medical treatment: the use of platelet aggregation inhibitors and heparin influences the rate of early rethrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Percutaneous peripheral laser angioplasty: initial clinical results]

Laser angioplasty has developed as a new method for the treatment of peripheral arterial occlusive disease. In 19 patients with high grade stenoses or obstructions of the superficial femoral, popliteal or posterior tibial arteries (Fontaine stage IIa-IV) percutaneous transluminal laser angioplasty was performed using a novel laser catheter system. The laser catheter itself is made of polyethylene. Its distal tip is formed ovally and marked X-ray densely. A silica fiber (core diameter 0.6 mm) for delivering the laser energy is inserted into the laser catheter. Through a sheath with hemostatic valve, laser catheter and silica fiber are introduced into the artery and then advanced to the stenosis over a guide wire. During laser angioplasty, laser catheter and silica fiber are rotated around the guide wire. We use a cw-Nd: YAG laser with a wavelength of 1064 nm. The mean degree of stenosis decreased from 92 +/- 12% before to 31 +/- 19% after laser angioplasty. By conventional balloon angioplasty a further reduction of the degree of stenosis down to 15 +/- 20% was achieved. The mean systolic Doppler ankle-arm pressure ratio improved from 0.56 +/- 0.25 before laser angioplasty to 0.89 +/- 0.24 after combined laser and balloon angioplasty. In seven patients, clinically non-significant distal embolization occurred. In no patient there was a perforation of the arterial wall. Up to now, digital subtraction angiography 3 months after laser angioplasty has been performed in five patients and showed patency of all lesions. The mean systolic Doppler ankle-arm pressure ratio was 0.84 +/- 0.20.

[Special complications in leg phlebography]

Some rare, but serious, complications during leg and pelvic phlebography are described. One fatal pulmonary embolus and six cases of necrosis of the dorsum of the foot due to phlebography were encountered. The causes, pathogenetic factors and other possible complications are discussed. Extravasation of contrast due to puncture on the lateral side of the foot, or near the ankle joint, leads to the formation of a contrast bleb which may proceed to tissue necrosis.

Results of percutaneous transluminal angioplasty

Percutaneous transluminal angioplasty (Dotter technique) was used in 2,942 cases of iliofemoral atheromatous disease. Results varied with the characteristics of the obstructing lesion (length and location) and the clinical stage of ischemia (claudication, rest pain, gangrene). Based on the foregoing, angioplasty is done either as the preferred primary treatment or for the relief of clinically advanced disease in patients unsuitable for high risk surgery. Success is favored by the use of aggregation inhibitors and single-use Teflon or balloon catheters; complications are few.

New technical trends in coronary laboratories

Increasing experience and improvement of the techniques used in coronary angiography and left ventriculography, have advanced patient safety and the proper assessment of coronary heart disease. High-resolution image intensifiers, coupled with the use of 50 or 25 frames-per-second cinematography or 100 mm spot film technique, offer diverse possibilities for optimal documentation of the morphologic findings. For an evaluation of both hemodynamics and cinematography, computer-assisted units increasingly simplify work and offer greater safety in procedures that assess ventricular function.

[Phlebography of the internal spermatic vein (author's transl)]

Phlebography of the internal spermatic vein in male patients suffering from infertility is a diagnostic procedure of low risk. In 432 patients examined for this condition, varicoceles were found, 67.5% of which occurred on the left, 13.8% on the right side. This fairly high number of varicoceles on the right side was surprising. It may be due to the technique, which requires standardisation and an experienced examiner in order to achieve a high rate of success. The possibility of a connection between unsatisfactory examination technique and unsatisfactory therapeutic results is discussed.

[Radiology of acute phlebothrombosis (author's transl)]

The difference in technique of phlebography in acute phlebothrombosis and that in chronic venous insufficiency is demonstrated. Since acute phlebothrombosis can be cured with good results by thrombectomy and fibrinolysis in the first few days of the disease, phlebography should be performed early, preferably the day on which the presence of acute thrombosis is suspected.

Selective sclerotherapy of the internal spermatic vein in patients with varicoceles

Percutaneous occlusion therapy of insufficient internal spermatic veins was performed successfully as an outpatient procedure in 155 patients with varicoceles. The administration of the sclerosing agent (Varicocid) through a catheter selectively introduced into the spermatic vein caused therapeutic occlusion. Follow-up studies, both clinical and phlebographic, confirmed the effectiveness of the treatment.

[The treatment of male infertility by selective catheterisation of the spermatic vein. Technique, indications, complications, results (author's transl)]

Sclerosis of the spermatic vein for male infertility and varicoceles was carried out in 84 patients by a percutaneous method. If the catheter is correctly placed in the spermatic vein, sclerosis is possible in almost all cases, as was shown by controlled examinations after periods of more than three months. Together with the radiologic changes, there was also an improvement in the spermatologic parameters. 58% of the patients examined after three months were regarded as fertile.

[The technique and results of spermatic vein phlebography in 136 men with primary sterility (author's transl)]

The results of selective phlebography of the spermatic vein in patients with primary sterility and suspected varicoceles are reported. In 60% of those examined there was left-sided, and in 8.8% right-sided, spermatic vein insufficiency or a varicocoele. The value of spermatic vein phlebography is borne out by the large number of anomalies of the venous system (67%) and by the finding of 82 left-sided varicoceles.