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Richard Pizzi is editor of The Hospitalist. He has been an editor at Frontline Medical Communications since 2015, and previously served as editor of MDedge publications Hospitalist News and ID Practitioner. He has also worked as an editor and in editorial management roles for HIMSS Media, MedTech Media, and the American Association for Clinical Chemistry. Follow him on Twitter @richpizzi
Ebola research update: February 2016
The struggle to defeat Ebola viral disease continues globally, although it may not always make the headlines. To catch up on what you may have missed, here are some notable news items and journal articles published over the past few weeks that are worth a look.
New research reveals that the Ebola virus is typically cleared from the blood within 16 days – meaning that the risk of infection from contact with a survivor is low. However, an exception to this is transmission via sexual intercourse due to the virus’ presence in semen for many months after a patient has otherwise recovered. Contact with the patient’s blood is also a longer-term risk.
A report in Clinical Infectious Diseases assesses two cases of Ebola viral disease (EVD) in pregnant women who survived, initially with intact pregnancies. Both patients had live second trimester fetuses in utero following cure, but each woman ultimately delivered a stillborn fetus with persistent EVD–polymerase chain reaction amniotic fluid positivity. The investigators say this highlights the need for research on possible infectivity of amniotic fluid after convalescence of the mother.
According to new research, extracts of the medicinal plant Cistus incanus attack Ebola and HIV virus particles and prevent them from multiplying in cultured cells. Since the antiviral activity of Cistus extracts differs from all clinically approved drugs, the researchers say Cistus-derived products could be an important complement to currently established drug regimens.
Investigators at the CDC used mice engrafted with human immune cells as a model for Ebola virus infection and disease progression. They demonstrated that mice devoid of their native immune response and reconstituted with a human innate and adaptive immune system are susceptible to infection and die of disease within approximately 2 weeks after inoculation with wild-type Ebola virus. Mice appear to offer a unique model for investigating the human immune response in EVD and an alternative animal model for EVD pathogenesis studies and therapeutic screening.
A study published in Scientific Reports shows the ability of a vaccine vector, based on a common herpesvirus called cytomegalovirus expressing Ebola virus glycoprotein, to provide protection against Ebola virus in the experimental rhesus macaque, non-human primate model. Investigators say the study is a step forward for the development of conventional Ebola virus vaccines for use in humans.
Researchers at the Yale School of Public Health developed computational models for disease transmission and infection progression to estimate the repercussions of the 2014-2015 West African Ebola outbreak on populations already at risk for malaria, HIV/AIDS, and tuberculosis. They estimated that a 50% reduction in access to healthcare services during the Ebola outbreak exacerbated malaria, HIV/AIDS, and tuberculosis mortality rates by additional death counts of 6,269 in Guinea; 1,535 in Liberia; and 2,819 in Sierra Leone.
A broad panel of neutralizing, anti–Ebola virus antibodies have been isolated from a survivor of the recent Zaire outbreak. Investigators said 77% of the monoclonal antibodies (mAbs) neutralize live EBOV, and several mAbs exhibit unprecedented potency. They said the results provide a framework for the design of new EBOV vaccine candidates and immunotherapies.
The Ebola epidemic in West Africa provides valuable lessons for how to respond to infectious disease epidemics generally, according to an analysis in Science. The report says rebuilding local health care infrastructures, improving capacity to respond more quickly to outbreaks, and considering multiple perspectives across disciplines during decision-making processes are the key areas for action.
A multicenter non-randomized trial of Ebola virus patients in Guinea found that favipiravir monotherapy, along with standardized care, merits further study in patients with medium to high viremia, but not in those with very high viremia. The results also confirm that viral load is a strong predictor of mortality.
According to a report in the Journal of Infectious Diseases, the support from the World Health Organization’s polio program infrastructure, particularly the coordination mechanism adopted, the availability of skilled personnel in the polio program, and lessons learned from managing the polio eradication program greatly contributed to the speedy containment of the 2014 Ebola virus disease outbreak in Nigeria.
On Twitter @richpizzi
The struggle to defeat Ebola viral disease continues globally, although it may not always make the headlines. To catch up on what you may have missed, here are some notable news items and journal articles published over the past few weeks that are worth a look.
New research reveals that the Ebola virus is typically cleared from the blood within 16 days – meaning that the risk of infection from contact with a survivor is low. However, an exception to this is transmission via sexual intercourse due to the virus’ presence in semen for many months after a patient has otherwise recovered. Contact with the patient’s blood is also a longer-term risk.
A report in Clinical Infectious Diseases assesses two cases of Ebola viral disease (EVD) in pregnant women who survived, initially with intact pregnancies. Both patients had live second trimester fetuses in utero following cure, but each woman ultimately delivered a stillborn fetus with persistent EVD–polymerase chain reaction amniotic fluid positivity. The investigators say this highlights the need for research on possible infectivity of amniotic fluid after convalescence of the mother.
According to new research, extracts of the medicinal plant Cistus incanus attack Ebola and HIV virus particles and prevent them from multiplying in cultured cells. Since the antiviral activity of Cistus extracts differs from all clinically approved drugs, the researchers say Cistus-derived products could be an important complement to currently established drug regimens.
Investigators at the CDC used mice engrafted with human immune cells as a model for Ebola virus infection and disease progression. They demonstrated that mice devoid of their native immune response and reconstituted with a human innate and adaptive immune system are susceptible to infection and die of disease within approximately 2 weeks after inoculation with wild-type Ebola virus. Mice appear to offer a unique model for investigating the human immune response in EVD and an alternative animal model for EVD pathogenesis studies and therapeutic screening.
A study published in Scientific Reports shows the ability of a vaccine vector, based on a common herpesvirus called cytomegalovirus expressing Ebola virus glycoprotein, to provide protection against Ebola virus in the experimental rhesus macaque, non-human primate model. Investigators say the study is a step forward for the development of conventional Ebola virus vaccines for use in humans.
Researchers at the Yale School of Public Health developed computational models for disease transmission and infection progression to estimate the repercussions of the 2014-2015 West African Ebola outbreak on populations already at risk for malaria, HIV/AIDS, and tuberculosis. They estimated that a 50% reduction in access to healthcare services during the Ebola outbreak exacerbated malaria, HIV/AIDS, and tuberculosis mortality rates by additional death counts of 6,269 in Guinea; 1,535 in Liberia; and 2,819 in Sierra Leone.
A broad panel of neutralizing, anti–Ebola virus antibodies have been isolated from a survivor of the recent Zaire outbreak. Investigators said 77% of the monoclonal antibodies (mAbs) neutralize live EBOV, and several mAbs exhibit unprecedented potency. They said the results provide a framework for the design of new EBOV vaccine candidates and immunotherapies.
The Ebola epidemic in West Africa provides valuable lessons for how to respond to infectious disease epidemics generally, according to an analysis in Science. The report says rebuilding local health care infrastructures, improving capacity to respond more quickly to outbreaks, and considering multiple perspectives across disciplines during decision-making processes are the key areas for action.
A multicenter non-randomized trial of Ebola virus patients in Guinea found that favipiravir monotherapy, along with standardized care, merits further study in patients with medium to high viremia, but not in those with very high viremia. The results also confirm that viral load is a strong predictor of mortality.
According to a report in the Journal of Infectious Diseases, the support from the World Health Organization’s polio program infrastructure, particularly the coordination mechanism adopted, the availability of skilled personnel in the polio program, and lessons learned from managing the polio eradication program greatly contributed to the speedy containment of the 2014 Ebola virus disease outbreak in Nigeria.
On Twitter @richpizzi
The struggle to defeat Ebola viral disease continues globally, although it may not always make the headlines. To catch up on what you may have missed, here are some notable news items and journal articles published over the past few weeks that are worth a look.
New research reveals that the Ebola virus is typically cleared from the blood within 16 days – meaning that the risk of infection from contact with a survivor is low. However, an exception to this is transmission via sexual intercourse due to the virus’ presence in semen for many months after a patient has otherwise recovered. Contact with the patient’s blood is also a longer-term risk.
A report in Clinical Infectious Diseases assesses two cases of Ebola viral disease (EVD) in pregnant women who survived, initially with intact pregnancies. Both patients had live second trimester fetuses in utero following cure, but each woman ultimately delivered a stillborn fetus with persistent EVD–polymerase chain reaction amniotic fluid positivity. The investigators say this highlights the need for research on possible infectivity of amniotic fluid after convalescence of the mother.
According to new research, extracts of the medicinal plant Cistus incanus attack Ebola and HIV virus particles and prevent them from multiplying in cultured cells. Since the antiviral activity of Cistus extracts differs from all clinically approved drugs, the researchers say Cistus-derived products could be an important complement to currently established drug regimens.
Investigators at the CDC used mice engrafted with human immune cells as a model for Ebola virus infection and disease progression. They demonstrated that mice devoid of their native immune response and reconstituted with a human innate and adaptive immune system are susceptible to infection and die of disease within approximately 2 weeks after inoculation with wild-type Ebola virus. Mice appear to offer a unique model for investigating the human immune response in EVD and an alternative animal model for EVD pathogenesis studies and therapeutic screening.
A study published in Scientific Reports shows the ability of a vaccine vector, based on a common herpesvirus called cytomegalovirus expressing Ebola virus glycoprotein, to provide protection against Ebola virus in the experimental rhesus macaque, non-human primate model. Investigators say the study is a step forward for the development of conventional Ebola virus vaccines for use in humans.
Researchers at the Yale School of Public Health developed computational models for disease transmission and infection progression to estimate the repercussions of the 2014-2015 West African Ebola outbreak on populations already at risk for malaria, HIV/AIDS, and tuberculosis. They estimated that a 50% reduction in access to healthcare services during the Ebola outbreak exacerbated malaria, HIV/AIDS, and tuberculosis mortality rates by additional death counts of 6,269 in Guinea; 1,535 in Liberia; and 2,819 in Sierra Leone.
A broad panel of neutralizing, anti–Ebola virus antibodies have been isolated from a survivor of the recent Zaire outbreak. Investigators said 77% of the monoclonal antibodies (mAbs) neutralize live EBOV, and several mAbs exhibit unprecedented potency. They said the results provide a framework for the design of new EBOV vaccine candidates and immunotherapies.
The Ebola epidemic in West Africa provides valuable lessons for how to respond to infectious disease epidemics generally, according to an analysis in Science. The report says rebuilding local health care infrastructures, improving capacity to respond more quickly to outbreaks, and considering multiple perspectives across disciplines during decision-making processes are the key areas for action.
A multicenter non-randomized trial of Ebola virus patients in Guinea found that favipiravir monotherapy, along with standardized care, merits further study in patients with medium to high viremia, but not in those with very high viremia. The results also confirm that viral load is a strong predictor of mortality.
According to a report in the Journal of Infectious Diseases, the support from the World Health Organization’s polio program infrastructure, particularly the coordination mechanism adopted, the availability of skilled personnel in the polio program, and lessons learned from managing the polio eradication program greatly contributed to the speedy containment of the 2014 Ebola virus disease outbreak in Nigeria.
On Twitter @richpizzi
Test All Kidney Transplant Patients for Hepatitis E
All kidney transplant recipients with abnormal liver function test results should be tested for hepatitis E virus RNA, according to a recent finding by French investigators.
Hepatitis E virus (HEV) is most often transmitted through the fecal-oral route in contaminated drinking water or food, but it also can be transmitted by blood and blood products. A research letter from Dr. Vincent Mallett of the Université Paris Descartes Sorbonne Paris Cité and colleagues published in Annals of Internal Medicine reported a case of HEV transmission to a kidney transplant recipient through plasma exchange.
Nineteen months after a 48-year-old patient received a kidney transplant, Dr. Mallett and his colleagues detected HEV RNA genotype 3f in the patient’s blood based on sequencing, and the patient tested positive for anti-HEV IgG and negative for anti-HEV IgM. The physicians confirmed that the patient had been infected for more than 1 year by finding HEV RNA in a frozen plasma sample drawn 5 months after transplantation. The kidney donor had tested negative for HEV RNA, and the patient’s stored blood samples tested negative for HEV markers before transplantation.
The investigators said that the method of HEV transmission remained undetermined until the investigators tested for HEV RNA in stored samples of all 18 blood products used during the peritransplantation period. From a single sample of fresh frozen plasma from a donor who had tested negative on multiple occasions for hepatitis C virus, HIV-1 and -2, and hepatitis B virus before the plasma was used, the researchers recovered a strain of HEV identical to the one infecting the patient. This plasma had been used during a plasma exchange for treating acute humoral rejection.
Plasma exchange typically involves the removal of 2-5 L of plasma several times a week, Dr. Mallett and associates said, which often is replaced with donor plasma. If replacement involves 2.5 L (10 bags) of donor plasma, which is a typical amount, then the risk for HEV is 10 times greater than the risk involving a single bag.
“In some circumstances, replacement procedures use plasma that has been pooled from many donors and then treated with solvents and detergents to inactivate infectious agents,” they wrote. “However, HEV is not affected by this treatment, so pooling multiplies the risk for infection.”
On the basis of these findings, the coauthors said that “all kidney transplant recipients with abnormal liver function test results, especially those treated with plasma exchange, should be tested for HEV RNA.”
Read the letter in Annals of Internal Medicine (2016 Mar 1. doi: 10.7326/L15-0502).
All kidney transplant recipients with abnormal liver function test results should be tested for hepatitis E virus RNA, according to a recent finding by French investigators.
Hepatitis E virus (HEV) is most often transmitted through the fecal-oral route in contaminated drinking water or food, but it also can be transmitted by blood and blood products. A research letter from Dr. Vincent Mallett of the Université Paris Descartes Sorbonne Paris Cité and colleagues published in Annals of Internal Medicine reported a case of HEV transmission to a kidney transplant recipient through plasma exchange.
Nineteen months after a 48-year-old patient received a kidney transplant, Dr. Mallett and his colleagues detected HEV RNA genotype 3f in the patient’s blood based on sequencing, and the patient tested positive for anti-HEV IgG and negative for anti-HEV IgM. The physicians confirmed that the patient had been infected for more than 1 year by finding HEV RNA in a frozen plasma sample drawn 5 months after transplantation. The kidney donor had tested negative for HEV RNA, and the patient’s stored blood samples tested negative for HEV markers before transplantation.
The investigators said that the method of HEV transmission remained undetermined until the investigators tested for HEV RNA in stored samples of all 18 blood products used during the peritransplantation period. From a single sample of fresh frozen plasma from a donor who had tested negative on multiple occasions for hepatitis C virus, HIV-1 and -2, and hepatitis B virus before the plasma was used, the researchers recovered a strain of HEV identical to the one infecting the patient. This plasma had been used during a plasma exchange for treating acute humoral rejection.
Plasma exchange typically involves the removal of 2-5 L of plasma several times a week, Dr. Mallett and associates said, which often is replaced with donor plasma. If replacement involves 2.5 L (10 bags) of donor plasma, which is a typical amount, then the risk for HEV is 10 times greater than the risk involving a single bag.
“In some circumstances, replacement procedures use plasma that has been pooled from many donors and then treated with solvents and detergents to inactivate infectious agents,” they wrote. “However, HEV is not affected by this treatment, so pooling multiplies the risk for infection.”
On the basis of these findings, the coauthors said that “all kidney transplant recipients with abnormal liver function test results, especially those treated with plasma exchange, should be tested for HEV RNA.”
Read the letter in Annals of Internal Medicine (2016 Mar 1. doi: 10.7326/L15-0502).
All kidney transplant recipients with abnormal liver function test results should be tested for hepatitis E virus RNA, according to a recent finding by French investigators.
Hepatitis E virus (HEV) is most often transmitted through the fecal-oral route in contaminated drinking water or food, but it also can be transmitted by blood and blood products. A research letter from Dr. Vincent Mallett of the Université Paris Descartes Sorbonne Paris Cité and colleagues published in Annals of Internal Medicine reported a case of HEV transmission to a kidney transplant recipient through plasma exchange.
Nineteen months after a 48-year-old patient received a kidney transplant, Dr. Mallett and his colleagues detected HEV RNA genotype 3f in the patient’s blood based on sequencing, and the patient tested positive for anti-HEV IgG and negative for anti-HEV IgM. The physicians confirmed that the patient had been infected for more than 1 year by finding HEV RNA in a frozen plasma sample drawn 5 months after transplantation. The kidney donor had tested negative for HEV RNA, and the patient’s stored blood samples tested negative for HEV markers before transplantation.
The investigators said that the method of HEV transmission remained undetermined until the investigators tested for HEV RNA in stored samples of all 18 blood products used during the peritransplantation period. From a single sample of fresh frozen plasma from a donor who had tested negative on multiple occasions for hepatitis C virus, HIV-1 and -2, and hepatitis B virus before the plasma was used, the researchers recovered a strain of HEV identical to the one infecting the patient. This plasma had been used during a plasma exchange for treating acute humoral rejection.
Plasma exchange typically involves the removal of 2-5 L of plasma several times a week, Dr. Mallett and associates said, which often is replaced with donor plasma. If replacement involves 2.5 L (10 bags) of donor plasma, which is a typical amount, then the risk for HEV is 10 times greater than the risk involving a single bag.
“In some circumstances, replacement procedures use plasma that has been pooled from many donors and then treated with solvents and detergents to inactivate infectious agents,” they wrote. “However, HEV is not affected by this treatment, so pooling multiplies the risk for infection.”
On the basis of these findings, the coauthors said that “all kidney transplant recipients with abnormal liver function test results, especially those treated with plasma exchange, should be tested for HEV RNA.”
Read the letter in Annals of Internal Medicine (2016 Mar 1. doi: 10.7326/L15-0502).
FROM ANNALS OF INTERNAL MEDICINE
Test all kidney transplant patients for hepatitis E
All kidney transplant recipients with abnormal liver function test results should be tested for hepatitis E virus RNA, according to a recent finding by French investigators.
Hepatitis E virus (HEV) is most often transmitted through the fecal-oral route in contaminated drinking water or food, but it also can be transmitted by blood and blood products. A research letter from Dr. Vincent Mallett of the Université Paris Descartes Sorbonne Paris Cité and colleagues published in Annals of Internal Medicine reported a case of HEV transmission to a kidney transplant recipient through plasma exchange.
Nineteen months after a 48-year-old patient received a kidney transplant, Dr. Mallett and his colleagues detected HEV RNA genotype 3f in the patient’s blood based on sequencing, and the patient tested positive for anti-HEV IgG and negative for anti-HEV IgM. The physicians confirmed that the patient had been infected for more than 1 year by finding HEV RNA in a frozen plasma sample drawn 5 months after transplantation. The kidney donor had tested negative for HEV RNA, and the patient’s stored blood samples tested negative for HEV markers before transplantation.
The investigators said that the method of HEV transmission remained undetermined until the investigators tested for HEV RNA in stored samples of all 18 blood products used during the peritransplantation period. From a single sample of fresh frozen plasma from a donor who had tested negative on multiple occasions for hepatitis C virus, HIV-1 and -2, and hepatitis B virus before the plasma was used, the researchers recovered a strain of HEV identical to the one infecting the patient. This plasma had been used during a plasma exchange for treating acute humoral rejection.
Plasma exchange typically involves the removal of 2-5 L of plasma several times a week, Dr. Mallett and associates said, which often is replaced with donor plasma. If replacement involves 2.5 L (10 bags) of donor plasma, which is a typical amount, then the risk for HEV is 10 times greater than the risk involving a single bag.
“In some circumstances, replacement procedures use plasma that has been pooled from many donors and then treated with solvents and detergents to inactivate infectious agents,” they wrote. “However, HEV is not affected by this treatment, so pooling multiplies the risk for infection.”
On the basis of these findings, the coauthors said that “all kidney transplant recipients with abnormal liver function test results, especially those treated with plasma exchange, should be tested for HEV RNA.”
Read the letter in Annals of Internal Medicine (2016 Mar 1. doi: 10.7326/L15-0502).
On Twitter @richpizzi
All kidney transplant recipients with abnormal liver function test results should be tested for hepatitis E virus RNA, according to a recent finding by French investigators.
Hepatitis E virus (HEV) is most often transmitted through the fecal-oral route in contaminated drinking water or food, but it also can be transmitted by blood and blood products. A research letter from Dr. Vincent Mallett of the Université Paris Descartes Sorbonne Paris Cité and colleagues published in Annals of Internal Medicine reported a case of HEV transmission to a kidney transplant recipient through plasma exchange.
Nineteen months after a 48-year-old patient received a kidney transplant, Dr. Mallett and his colleagues detected HEV RNA genotype 3f in the patient’s blood based on sequencing, and the patient tested positive for anti-HEV IgG and negative for anti-HEV IgM. The physicians confirmed that the patient had been infected for more than 1 year by finding HEV RNA in a frozen plasma sample drawn 5 months after transplantation. The kidney donor had tested negative for HEV RNA, and the patient’s stored blood samples tested negative for HEV markers before transplantation.
The investigators said that the method of HEV transmission remained undetermined until the investigators tested for HEV RNA in stored samples of all 18 blood products used during the peritransplantation period. From a single sample of fresh frozen plasma from a donor who had tested negative on multiple occasions for hepatitis C virus, HIV-1 and -2, and hepatitis B virus before the plasma was used, the researchers recovered a strain of HEV identical to the one infecting the patient. This plasma had been used during a plasma exchange for treating acute humoral rejection.
Plasma exchange typically involves the removal of 2-5 L of plasma several times a week, Dr. Mallett and associates said, which often is replaced with donor plasma. If replacement involves 2.5 L (10 bags) of donor plasma, which is a typical amount, then the risk for HEV is 10 times greater than the risk involving a single bag.
“In some circumstances, replacement procedures use plasma that has been pooled from many donors and then treated with solvents and detergents to inactivate infectious agents,” they wrote. “However, HEV is not affected by this treatment, so pooling multiplies the risk for infection.”
On the basis of these findings, the coauthors said that “all kidney transplant recipients with abnormal liver function test results, especially those treated with plasma exchange, should be tested for HEV RNA.”
Read the letter in Annals of Internal Medicine (2016 Mar 1. doi: 10.7326/L15-0502).
On Twitter @richpizzi
All kidney transplant recipients with abnormal liver function test results should be tested for hepatitis E virus RNA, according to a recent finding by French investigators.
Hepatitis E virus (HEV) is most often transmitted through the fecal-oral route in contaminated drinking water or food, but it also can be transmitted by blood and blood products. A research letter from Dr. Vincent Mallett of the Université Paris Descartes Sorbonne Paris Cité and colleagues published in Annals of Internal Medicine reported a case of HEV transmission to a kidney transplant recipient through plasma exchange.
Nineteen months after a 48-year-old patient received a kidney transplant, Dr. Mallett and his colleagues detected HEV RNA genotype 3f in the patient’s blood based on sequencing, and the patient tested positive for anti-HEV IgG and negative for anti-HEV IgM. The physicians confirmed that the patient had been infected for more than 1 year by finding HEV RNA in a frozen plasma sample drawn 5 months after transplantation. The kidney donor had tested negative for HEV RNA, and the patient’s stored blood samples tested negative for HEV markers before transplantation.
The investigators said that the method of HEV transmission remained undetermined until the investigators tested for HEV RNA in stored samples of all 18 blood products used during the peritransplantation period. From a single sample of fresh frozen plasma from a donor who had tested negative on multiple occasions for hepatitis C virus, HIV-1 and -2, and hepatitis B virus before the plasma was used, the researchers recovered a strain of HEV identical to the one infecting the patient. This plasma had been used during a plasma exchange for treating acute humoral rejection.
Plasma exchange typically involves the removal of 2-5 L of plasma several times a week, Dr. Mallett and associates said, which often is replaced with donor plasma. If replacement involves 2.5 L (10 bags) of donor plasma, which is a typical amount, then the risk for HEV is 10 times greater than the risk involving a single bag.
“In some circumstances, replacement procedures use plasma that has been pooled from many donors and then treated with solvents and detergents to inactivate infectious agents,” they wrote. “However, HEV is not affected by this treatment, so pooling multiplies the risk for infection.”
On the basis of these findings, the coauthors said that “all kidney transplant recipients with abnormal liver function test results, especially those treated with plasma exchange, should be tested for HEV RNA.”
Read the letter in Annals of Internal Medicine (2016 Mar 1. doi: 10.7326/L15-0502).
On Twitter @richpizzi
FROM ANNALS OF INTERNAL MEDICINE
HIV research update: Late February 2016
A large volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
A review of recent findings on the prevalence and incidence of fractures in people living with HIV found that the effects of HIV infection alone, and the initiation of antiretroviral therapy, are associated with significant bone loss in individuals with HIV infection, resulting in osteopenia and osteoporosis. Investigators said fragility fractures occur at a prevalence of about 10% (about twice that of the general population), and the increased propensity of falls results in greater fracture prevalence, morbidity and mortality.
A study in the journal Substance Use and Misuse found risk behaviors among heroin injectors in the Colombian cities of Medellín and Pereira held implications for possible increased HIV transmission among this population. While HIV prevalence is fairly low among people who inject drugs in the Colombian cities studied, investigators said potential risk exists for the spread of HIV in this population given their widespread needle-sharing practices, high rate of new injector initiation, and unsafe syringe-cleaning practices.
Researchers at Johns Hopkins and Emory University said the achievement of White House National HIV/AIDS Strategy (NHAS) progress indicators for screening, linkage, and retention in care can substantially reduce the burden of HIV in the United States, but continued and increased financial investment will be required.
HIV infection of human immune cells triggers a massive increase in methylation to both human and viral RNA, aiding replication of the virus, according to research published online in Nature Microbiology. The research team, based at the University of California, San Diego, discovered N6-methyladenosine modifications in HIV RNA for the first time.
A study in the journal AIDS found that increasing CD8 T-cell levels and persistent CRP elevation are independent predictors of angiographic restenosis in HIV patients. The authors say these markers should be closely monitored in patients undergoing percutaneous coronary intervention.
Despite improvements in life expectancy among people diagnosed with an HIV infection during 2008-2011, disparities by sex and by race/ethnicity persist, say authors of a study published in JAIDS. The overall life expectancy after HIV diagnosis in the United States, increased 3.43 years from 25.43 in 2008, to 28.86 in 2011.
An examination of the incidence and risk factors of AIDS-defining and other cancers in pediatric antiretroviral therapy (ART) programs in South Africa found that early HIV diagnosis and linkage to care, with start of ART before advanced immunodeficiency develops, may substantially reduce the burden of cancer in pediatric patients.
Antiretroviral stewardship programs can be considered a core strategy for continuous quality improvement in the management of HIV-infected children and adolescents, said authors of a study published in the Pediatric Infectious Disease Journal. Researchers used a comprehensive assessment tool to screen pediatric patients for issues related to genotypic resistance, virologic/immunologic response, drug-drug interactions, side effects, and potential for regimen simplification.
Investigators for a retrospective cohort analysis of HIV-infected individuals in New York State discovered that a number of patient characteristics were independently associated with hospital readmission within 30 days. The authors say behavioral health disorders and comorbid conditions may be the strongest predictors of readmission in persons living with HIV/AIDS and might ultimately compromise the quality of care and result in harmful discontinuity of medical treatment.
Researchers developed and validated an HIV risk-assessment tool that predicts HIV acquisition among African women over 1 year. The authors say the use of a validated risk score could improve efficiency of recruitment into HIV prevention research and inform scale-up of HIV prevention strategies in women at highest risk.
Empiric TB treatment of HIV-seropositive, smear-negative, presumed pulmonary TB patients with one or more danger signs is associated with improved 8-week survival, according to a study published in JAIDS. The authors say enhanced implementation of the 2007 WHO empiric treatment recommendations should be encouraged whenever and wherever rapid and highly sensitive diagnostic tests for TB are unavailable.
On Twitter @richpizzi
A large volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
A review of recent findings on the prevalence and incidence of fractures in people living with HIV found that the effects of HIV infection alone, and the initiation of antiretroviral therapy, are associated with significant bone loss in individuals with HIV infection, resulting in osteopenia and osteoporosis. Investigators said fragility fractures occur at a prevalence of about 10% (about twice that of the general population), and the increased propensity of falls results in greater fracture prevalence, morbidity and mortality.
A study in the journal Substance Use and Misuse found risk behaviors among heroin injectors in the Colombian cities of Medellín and Pereira held implications for possible increased HIV transmission among this population. While HIV prevalence is fairly low among people who inject drugs in the Colombian cities studied, investigators said potential risk exists for the spread of HIV in this population given their widespread needle-sharing practices, high rate of new injector initiation, and unsafe syringe-cleaning practices.
Researchers at Johns Hopkins and Emory University said the achievement of White House National HIV/AIDS Strategy (NHAS) progress indicators for screening, linkage, and retention in care can substantially reduce the burden of HIV in the United States, but continued and increased financial investment will be required.
HIV infection of human immune cells triggers a massive increase in methylation to both human and viral RNA, aiding replication of the virus, according to research published online in Nature Microbiology. The research team, based at the University of California, San Diego, discovered N6-methyladenosine modifications in HIV RNA for the first time.
A study in the journal AIDS found that increasing CD8 T-cell levels and persistent CRP elevation are independent predictors of angiographic restenosis in HIV patients. The authors say these markers should be closely monitored in patients undergoing percutaneous coronary intervention.
Despite improvements in life expectancy among people diagnosed with an HIV infection during 2008-2011, disparities by sex and by race/ethnicity persist, say authors of a study published in JAIDS. The overall life expectancy after HIV diagnosis in the United States, increased 3.43 years from 25.43 in 2008, to 28.86 in 2011.
An examination of the incidence and risk factors of AIDS-defining and other cancers in pediatric antiretroviral therapy (ART) programs in South Africa found that early HIV diagnosis and linkage to care, with start of ART before advanced immunodeficiency develops, may substantially reduce the burden of cancer in pediatric patients.
Antiretroviral stewardship programs can be considered a core strategy for continuous quality improvement in the management of HIV-infected children and adolescents, said authors of a study published in the Pediatric Infectious Disease Journal. Researchers used a comprehensive assessment tool to screen pediatric patients for issues related to genotypic resistance, virologic/immunologic response, drug-drug interactions, side effects, and potential for regimen simplification.
Investigators for a retrospective cohort analysis of HIV-infected individuals in New York State discovered that a number of patient characteristics were independently associated with hospital readmission within 30 days. The authors say behavioral health disorders and comorbid conditions may be the strongest predictors of readmission in persons living with HIV/AIDS and might ultimately compromise the quality of care and result in harmful discontinuity of medical treatment.
Researchers developed and validated an HIV risk-assessment tool that predicts HIV acquisition among African women over 1 year. The authors say the use of a validated risk score could improve efficiency of recruitment into HIV prevention research and inform scale-up of HIV prevention strategies in women at highest risk.
Empiric TB treatment of HIV-seropositive, smear-negative, presumed pulmonary TB patients with one or more danger signs is associated with improved 8-week survival, according to a study published in JAIDS. The authors say enhanced implementation of the 2007 WHO empiric treatment recommendations should be encouraged whenever and wherever rapid and highly sensitive diagnostic tests for TB are unavailable.
On Twitter @richpizzi
A large volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
A review of recent findings on the prevalence and incidence of fractures in people living with HIV found that the effects of HIV infection alone, and the initiation of antiretroviral therapy, are associated with significant bone loss in individuals with HIV infection, resulting in osteopenia and osteoporosis. Investigators said fragility fractures occur at a prevalence of about 10% (about twice that of the general population), and the increased propensity of falls results in greater fracture prevalence, morbidity and mortality.
A study in the journal Substance Use and Misuse found risk behaviors among heroin injectors in the Colombian cities of Medellín and Pereira held implications for possible increased HIV transmission among this population. While HIV prevalence is fairly low among people who inject drugs in the Colombian cities studied, investigators said potential risk exists for the spread of HIV in this population given their widespread needle-sharing practices, high rate of new injector initiation, and unsafe syringe-cleaning practices.
Researchers at Johns Hopkins and Emory University said the achievement of White House National HIV/AIDS Strategy (NHAS) progress indicators for screening, linkage, and retention in care can substantially reduce the burden of HIV in the United States, but continued and increased financial investment will be required.
HIV infection of human immune cells triggers a massive increase in methylation to both human and viral RNA, aiding replication of the virus, according to research published online in Nature Microbiology. The research team, based at the University of California, San Diego, discovered N6-methyladenosine modifications in HIV RNA for the first time.
A study in the journal AIDS found that increasing CD8 T-cell levels and persistent CRP elevation are independent predictors of angiographic restenosis in HIV patients. The authors say these markers should be closely monitored in patients undergoing percutaneous coronary intervention.
Despite improvements in life expectancy among people diagnosed with an HIV infection during 2008-2011, disparities by sex and by race/ethnicity persist, say authors of a study published in JAIDS. The overall life expectancy after HIV diagnosis in the United States, increased 3.43 years from 25.43 in 2008, to 28.86 in 2011.
An examination of the incidence and risk factors of AIDS-defining and other cancers in pediatric antiretroviral therapy (ART) programs in South Africa found that early HIV diagnosis and linkage to care, with start of ART before advanced immunodeficiency develops, may substantially reduce the burden of cancer in pediatric patients.
Antiretroviral stewardship programs can be considered a core strategy for continuous quality improvement in the management of HIV-infected children and adolescents, said authors of a study published in the Pediatric Infectious Disease Journal. Researchers used a comprehensive assessment tool to screen pediatric patients for issues related to genotypic resistance, virologic/immunologic response, drug-drug interactions, side effects, and potential for regimen simplification.
Investigators for a retrospective cohort analysis of HIV-infected individuals in New York State discovered that a number of patient characteristics were independently associated with hospital readmission within 30 days. The authors say behavioral health disorders and comorbid conditions may be the strongest predictors of readmission in persons living with HIV/AIDS and might ultimately compromise the quality of care and result in harmful discontinuity of medical treatment.
Researchers developed and validated an HIV risk-assessment tool that predicts HIV acquisition among African women over 1 year. The authors say the use of a validated risk score could improve efficiency of recruitment into HIV prevention research and inform scale-up of HIV prevention strategies in women at highest risk.
Empiric TB treatment of HIV-seropositive, smear-negative, presumed pulmonary TB patients with one or more danger signs is associated with improved 8-week survival, according to a study published in JAIDS. The authors say enhanced implementation of the 2007 WHO empiric treatment recommendations should be encouraged whenever and wherever rapid and highly sensitive diagnostic tests for TB are unavailable.
On Twitter @richpizzi
FDA revises Olysio label after adverse reactions in East Asian patients
The U.S. Food and Drug Administration has revised labeling for the hepatitis C drug Olysio (simeprevir) after adverse reactions were experienced by East Asian patients during a phase III trial.
Olysio, produced by Janssen Products LP, is a hepatitis C virus NS3/4A protease inhibitor indicated for the treatment of chronic hepatitis C (CHC) genotype 1 or 4 infection as a component of a combination antiviral treatment regimen. It was initially approved by the FDA in November 2013.
The update was announced in a March 1 FDA Hepatitis Email Updates letter signed by Richard Klein and his colleagues at the FDA Office of Health and Constituent Affairs. The updated labeling comes as a result of a randomized, double-blind phase III trial (the TIGER trial) conducted in China and South Korea. Olysio, in combination with Peg interferon (IFN) -alfa and ribavirin (RBV), was studied in treatment-naive subjects with chronic HCV genotype 1 infection.
The TIGER investigators observed a higher incidence of the laboratory abnormality hyperbilirubinemia in trial subjects receiving 150 mg Olysio plus Peg IFN-alfa and RBV, compared with patients receiving placebo plus Peg IFN-alfa and RBV. Elevation of total bilirubin was observed in 66% (99/151) of subjects treated with 150 mg Olysio plus Peg IFN-alfa and RBV and in 26% (40/152) of subjects treated with placebo plus Peg IFN-alfa and RBV. Bilirubin elevations were mainly grade 1 or grade 2. Grade 3 elevations in bilirubin were observed in 9% (13/151) of subjects treated with 150 mg Olysio plus Peg IFN-alfa and RBV and in 1% (2/152) of subjects treated with placebo plus Peg IFN-alfa and RBV. There were no grade 4 elevations in bilirubin.
Importantly, the bilirubin elevations were not associated with increases in liver transaminases and were reversible after the end of treatment.
The new labeling on Olysio includes the following: “Patients of East Asian ancestry exhibit higher simeprevir plasma exposures, but no dosage adjustment is required based on race. In a phase III trial conducted in China and South Korea, the mean plasma exposure of simeprevir in East Asian HCV-infected subjects was 2.1-fold higher, compared with non Asian HCV-infected subjects in a pooled phase III population from global trials.”
To read the FDA labeling for Olysio, the email announcement suggests visiting the Drugs@FDA website or the DailyMed website managed by the National Library of Medicine. As of this writing, these sites have yet to be updated.
On Twitter @richpizzi
The U.S. Food and Drug Administration has revised labeling for the hepatitis C drug Olysio (simeprevir) after adverse reactions were experienced by East Asian patients during a phase III trial.
Olysio, produced by Janssen Products LP, is a hepatitis C virus NS3/4A protease inhibitor indicated for the treatment of chronic hepatitis C (CHC) genotype 1 or 4 infection as a component of a combination antiviral treatment regimen. It was initially approved by the FDA in November 2013.
The update was announced in a March 1 FDA Hepatitis Email Updates letter signed by Richard Klein and his colleagues at the FDA Office of Health and Constituent Affairs. The updated labeling comes as a result of a randomized, double-blind phase III trial (the TIGER trial) conducted in China and South Korea. Olysio, in combination with Peg interferon (IFN) -alfa and ribavirin (RBV), was studied in treatment-naive subjects with chronic HCV genotype 1 infection.
The TIGER investigators observed a higher incidence of the laboratory abnormality hyperbilirubinemia in trial subjects receiving 150 mg Olysio plus Peg IFN-alfa and RBV, compared with patients receiving placebo plus Peg IFN-alfa and RBV. Elevation of total bilirubin was observed in 66% (99/151) of subjects treated with 150 mg Olysio plus Peg IFN-alfa and RBV and in 26% (40/152) of subjects treated with placebo plus Peg IFN-alfa and RBV. Bilirubin elevations were mainly grade 1 or grade 2. Grade 3 elevations in bilirubin were observed in 9% (13/151) of subjects treated with 150 mg Olysio plus Peg IFN-alfa and RBV and in 1% (2/152) of subjects treated with placebo plus Peg IFN-alfa and RBV. There were no grade 4 elevations in bilirubin.
Importantly, the bilirubin elevations were not associated with increases in liver transaminases and were reversible after the end of treatment.
The new labeling on Olysio includes the following: “Patients of East Asian ancestry exhibit higher simeprevir plasma exposures, but no dosage adjustment is required based on race. In a phase III trial conducted in China and South Korea, the mean plasma exposure of simeprevir in East Asian HCV-infected subjects was 2.1-fold higher, compared with non Asian HCV-infected subjects in a pooled phase III population from global trials.”
To read the FDA labeling for Olysio, the email announcement suggests visiting the Drugs@FDA website or the DailyMed website managed by the National Library of Medicine. As of this writing, these sites have yet to be updated.
On Twitter @richpizzi
The U.S. Food and Drug Administration has revised labeling for the hepatitis C drug Olysio (simeprevir) after adverse reactions were experienced by East Asian patients during a phase III trial.
Olysio, produced by Janssen Products LP, is a hepatitis C virus NS3/4A protease inhibitor indicated for the treatment of chronic hepatitis C (CHC) genotype 1 or 4 infection as a component of a combination antiviral treatment regimen. It was initially approved by the FDA in November 2013.
The update was announced in a March 1 FDA Hepatitis Email Updates letter signed by Richard Klein and his colleagues at the FDA Office of Health and Constituent Affairs. The updated labeling comes as a result of a randomized, double-blind phase III trial (the TIGER trial) conducted in China and South Korea. Olysio, in combination with Peg interferon (IFN) -alfa and ribavirin (RBV), was studied in treatment-naive subjects with chronic HCV genotype 1 infection.
The TIGER investigators observed a higher incidence of the laboratory abnormality hyperbilirubinemia in trial subjects receiving 150 mg Olysio plus Peg IFN-alfa and RBV, compared with patients receiving placebo plus Peg IFN-alfa and RBV. Elevation of total bilirubin was observed in 66% (99/151) of subjects treated with 150 mg Olysio plus Peg IFN-alfa and RBV and in 26% (40/152) of subjects treated with placebo plus Peg IFN-alfa and RBV. Bilirubin elevations were mainly grade 1 or grade 2. Grade 3 elevations in bilirubin were observed in 9% (13/151) of subjects treated with 150 mg Olysio plus Peg IFN-alfa and RBV and in 1% (2/152) of subjects treated with placebo plus Peg IFN-alfa and RBV. There were no grade 4 elevations in bilirubin.
Importantly, the bilirubin elevations were not associated with increases in liver transaminases and were reversible after the end of treatment.
The new labeling on Olysio includes the following: “Patients of East Asian ancestry exhibit higher simeprevir plasma exposures, but no dosage adjustment is required based on race. In a phase III trial conducted in China and South Korea, the mean plasma exposure of simeprevir in East Asian HCV-infected subjects was 2.1-fold higher, compared with non Asian HCV-infected subjects in a pooled phase III population from global trials.”
To read the FDA labeling for Olysio, the email announcement suggests visiting the Drugs@FDA website or the DailyMed website managed by the National Library of Medicine. As of this writing, these sites have yet to be updated.
On Twitter @richpizzi
HIV drug abacavir linked with higher CVD risk
The antiretroviral drug abacavir was associated with a more than twofold increased risk of cardiovascular disease in a cohort study of 8,154 HIV-infected patients.
Lead investigator Dr. Michael J. Silverberg of Kaiser Permanente Northern California, Oakland, and his colleagues followed HIV-infected adults initiating antiretroviral therapy at Kaiser Permanente during 1998-2011 until the earliest sign of coronary heart disease or ischemic stroke, health plan disenrollment, death, or the end of the study (J Acquir Immune Defic Syndr. 2016;71:413-9)
Among the 8,154 subjects, at least one cardiovascular disease (CVD) event occurred in 3.4% in the abacavir group and 2.1% in the group initiating regimens without abacavir. When initiating antiretroviral therapy, abacavir users had more renal dysfunction (7.0% vs. 3.3%, a significant difference). Compared with patients initiating regimens without abacavir, abacavir users had a 2.2-fold higher risk of CVD in an intention-to-treat analysis (hazard ratio, 2.2; 95% confidence interval [CI], 1.4-3.5), and a 2.7-fold higher risk when remaining on their initial regimens for 1 year or more (HR, 2.7; 95% CI, 1.5-5.0), and a 2.1-fold higher risk in per protocol analysis (HR, 2.1; 95% CI, 0.9-5.0).
The higher risk of CVD was not explained by preferential use of abacavir in patients with renal dysfunction or other risk factors. The excess risk of CVD in the HIV-infected study population has decreased over time, but abacavir may be one factor that continues to contribute to CVD among HIV patients, the researchers said.
“Like tenofovir, for which physicians must weigh the benefits of the medication against risk of nephrotoxicity, physicians prescribing abacavir must now consider its benefits and general tolerability in light of evidence of CVD risk,” they concluded.
Read the full study in JAIDS (J Acquir Immune Defic Syndr. 2016;71:413-9)
On Twitter @richpizzi
The antiretroviral drug abacavir was associated with a more than twofold increased risk of cardiovascular disease in a cohort study of 8,154 HIV-infected patients.
Lead investigator Dr. Michael J. Silverberg of Kaiser Permanente Northern California, Oakland, and his colleagues followed HIV-infected adults initiating antiretroviral therapy at Kaiser Permanente during 1998-2011 until the earliest sign of coronary heart disease or ischemic stroke, health plan disenrollment, death, or the end of the study (J Acquir Immune Defic Syndr. 2016;71:413-9)
Among the 8,154 subjects, at least one cardiovascular disease (CVD) event occurred in 3.4% in the abacavir group and 2.1% in the group initiating regimens without abacavir. When initiating antiretroviral therapy, abacavir users had more renal dysfunction (7.0% vs. 3.3%, a significant difference). Compared with patients initiating regimens without abacavir, abacavir users had a 2.2-fold higher risk of CVD in an intention-to-treat analysis (hazard ratio, 2.2; 95% confidence interval [CI], 1.4-3.5), and a 2.7-fold higher risk when remaining on their initial regimens for 1 year or more (HR, 2.7; 95% CI, 1.5-5.0), and a 2.1-fold higher risk in per protocol analysis (HR, 2.1; 95% CI, 0.9-5.0).
The higher risk of CVD was not explained by preferential use of abacavir in patients with renal dysfunction or other risk factors. The excess risk of CVD in the HIV-infected study population has decreased over time, but abacavir may be one factor that continues to contribute to CVD among HIV patients, the researchers said.
“Like tenofovir, for which physicians must weigh the benefits of the medication against risk of nephrotoxicity, physicians prescribing abacavir must now consider its benefits and general tolerability in light of evidence of CVD risk,” they concluded.
Read the full study in JAIDS (J Acquir Immune Defic Syndr. 2016;71:413-9)
On Twitter @richpizzi
The antiretroviral drug abacavir was associated with a more than twofold increased risk of cardiovascular disease in a cohort study of 8,154 HIV-infected patients.
Lead investigator Dr. Michael J. Silverberg of Kaiser Permanente Northern California, Oakland, and his colleagues followed HIV-infected adults initiating antiretroviral therapy at Kaiser Permanente during 1998-2011 until the earliest sign of coronary heart disease or ischemic stroke, health plan disenrollment, death, or the end of the study (J Acquir Immune Defic Syndr. 2016;71:413-9)
Among the 8,154 subjects, at least one cardiovascular disease (CVD) event occurred in 3.4% in the abacavir group and 2.1% in the group initiating regimens without abacavir. When initiating antiretroviral therapy, abacavir users had more renal dysfunction (7.0% vs. 3.3%, a significant difference). Compared with patients initiating regimens without abacavir, abacavir users had a 2.2-fold higher risk of CVD in an intention-to-treat analysis (hazard ratio, 2.2; 95% confidence interval [CI], 1.4-3.5), and a 2.7-fold higher risk when remaining on their initial regimens for 1 year or more (HR, 2.7; 95% CI, 1.5-5.0), and a 2.1-fold higher risk in per protocol analysis (HR, 2.1; 95% CI, 0.9-5.0).
The higher risk of CVD was not explained by preferential use of abacavir in patients with renal dysfunction or other risk factors. The excess risk of CVD in the HIV-infected study population has decreased over time, but abacavir may be one factor that continues to contribute to CVD among HIV patients, the researchers said.
“Like tenofovir, for which physicians must weigh the benefits of the medication against risk of nephrotoxicity, physicians prescribing abacavir must now consider its benefits and general tolerability in light of evidence of CVD risk,” they concluded.
Read the full study in JAIDS (J Acquir Immune Defic Syndr. 2016;71:413-9)
On Twitter @richpizzi
FROM JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Efavirenz linked with higher bone mass in children with HIV
BOSTON – Switching HIV-infected South African children from ritonavir-boosted lopinavir (LPV/r) to efavirenz (EFV)-based antiretroviral therapy improved bone mineral content in the children, compared with remaining on LPV/r, according to a study presented at the Conference on Retroviruses and Opportunistic Infections.
HIV infection affects bone accrual but there are limited data on how to optimize antiretrovirals to improve bone outcomes in HIV-infected children, said Dr. Stephen Arpadi, professor of pediatrics at Columbia University (N.Y.) Medical Center, and lead author of the study. To determine whether a preemptive switch from LPV/r to EFV antiretroviral therapy might be associated with beneficial outcomes in terms of children’s bone development, his team reviewed the results of a randomized clinical trial of HIV-infected children undertaken in Johannesburg, South Africa.
Two hundred twenty HIV-infected children aged 5-10 years (mean 6.4 years) were enrolled 1-4 years (mean 2.1 years) after randomization in the trial, while 180 similarly-aged HIV-uninfected children were recruited at the same site in Johannesburg for comparison. Among HIV-infected children, 110 were on EFV and 110 LPV/r at the time of assessment. All children also were on two nucleoside reverse transcriptase inhibitors, including 3TC (lamivudine) and ABC (abacavir), AZT, or d4T (stavudine). None were on TDF (tenofovir).
The investigators – part of the CHANGES Bone Study Team – assessed the children’s bone mineral content (BMC), fat mass, and lean body mass of the whole body by Dual-energy X-ray absorptiometry. Sex-specific BMC-for-height Z-scores for the infected children were generated using the BMC-for-height distribution of the uninfected controls. The children with HIV currently receiving EFV were compared with those on LPV/r.
Dr. Arpadi told CROI attendees that the BMC Z score was –0.49 in the EFV group and –1.07 in the LPV/r group, and that this association remained significant (P less than .001) and of a similar magnitude (Z-score difference, 0.58) after adjustment for age, fat mass, lean mass, vigorous physical activity, dietary vitamin D and calcium, CD4, and viral load. Sex-stratified analysis showed similar size effects in both boys and girls.
Higher fat and lean body mass also were independently associated with better bone mass outcomes in the children, Dr. Arpadi affirmed. “The use of bone friendly drugs may be beneficial for bone health in children with HIV,” he concluded.
The study was supported by the National Institutes of Health. Dr. Arpadi reported no conflicts of interest.
On Twitter @richpizzi
BOSTON – Switching HIV-infected South African children from ritonavir-boosted lopinavir (LPV/r) to efavirenz (EFV)-based antiretroviral therapy improved bone mineral content in the children, compared with remaining on LPV/r, according to a study presented at the Conference on Retroviruses and Opportunistic Infections.
HIV infection affects bone accrual but there are limited data on how to optimize antiretrovirals to improve bone outcomes in HIV-infected children, said Dr. Stephen Arpadi, professor of pediatrics at Columbia University (N.Y.) Medical Center, and lead author of the study. To determine whether a preemptive switch from LPV/r to EFV antiretroviral therapy might be associated with beneficial outcomes in terms of children’s bone development, his team reviewed the results of a randomized clinical trial of HIV-infected children undertaken in Johannesburg, South Africa.
Two hundred twenty HIV-infected children aged 5-10 years (mean 6.4 years) were enrolled 1-4 years (mean 2.1 years) after randomization in the trial, while 180 similarly-aged HIV-uninfected children were recruited at the same site in Johannesburg for comparison. Among HIV-infected children, 110 were on EFV and 110 LPV/r at the time of assessment. All children also were on two nucleoside reverse transcriptase inhibitors, including 3TC (lamivudine) and ABC (abacavir), AZT, or d4T (stavudine). None were on TDF (tenofovir).
The investigators – part of the CHANGES Bone Study Team – assessed the children’s bone mineral content (BMC), fat mass, and lean body mass of the whole body by Dual-energy X-ray absorptiometry. Sex-specific BMC-for-height Z-scores for the infected children were generated using the BMC-for-height distribution of the uninfected controls. The children with HIV currently receiving EFV were compared with those on LPV/r.
Dr. Arpadi told CROI attendees that the BMC Z score was –0.49 in the EFV group and –1.07 in the LPV/r group, and that this association remained significant (P less than .001) and of a similar magnitude (Z-score difference, 0.58) after adjustment for age, fat mass, lean mass, vigorous physical activity, dietary vitamin D and calcium, CD4, and viral load. Sex-stratified analysis showed similar size effects in both boys and girls.
Higher fat and lean body mass also were independently associated with better bone mass outcomes in the children, Dr. Arpadi affirmed. “The use of bone friendly drugs may be beneficial for bone health in children with HIV,” he concluded.
The study was supported by the National Institutes of Health. Dr. Arpadi reported no conflicts of interest.
On Twitter @richpizzi
BOSTON – Switching HIV-infected South African children from ritonavir-boosted lopinavir (LPV/r) to efavirenz (EFV)-based antiretroviral therapy improved bone mineral content in the children, compared with remaining on LPV/r, according to a study presented at the Conference on Retroviruses and Opportunistic Infections.
HIV infection affects bone accrual but there are limited data on how to optimize antiretrovirals to improve bone outcomes in HIV-infected children, said Dr. Stephen Arpadi, professor of pediatrics at Columbia University (N.Y.) Medical Center, and lead author of the study. To determine whether a preemptive switch from LPV/r to EFV antiretroviral therapy might be associated with beneficial outcomes in terms of children’s bone development, his team reviewed the results of a randomized clinical trial of HIV-infected children undertaken in Johannesburg, South Africa.
Two hundred twenty HIV-infected children aged 5-10 years (mean 6.4 years) were enrolled 1-4 years (mean 2.1 years) after randomization in the trial, while 180 similarly-aged HIV-uninfected children were recruited at the same site in Johannesburg for comparison. Among HIV-infected children, 110 were on EFV and 110 LPV/r at the time of assessment. All children also were on two nucleoside reverse transcriptase inhibitors, including 3TC (lamivudine) and ABC (abacavir), AZT, or d4T (stavudine). None were on TDF (tenofovir).
The investigators – part of the CHANGES Bone Study Team – assessed the children’s bone mineral content (BMC), fat mass, and lean body mass of the whole body by Dual-energy X-ray absorptiometry. Sex-specific BMC-for-height Z-scores for the infected children were generated using the BMC-for-height distribution of the uninfected controls. The children with HIV currently receiving EFV were compared with those on LPV/r.
Dr. Arpadi told CROI attendees that the BMC Z score was –0.49 in the EFV group and –1.07 in the LPV/r group, and that this association remained significant (P less than .001) and of a similar magnitude (Z-score difference, 0.58) after adjustment for age, fat mass, lean mass, vigorous physical activity, dietary vitamin D and calcium, CD4, and viral load. Sex-stratified analysis showed similar size effects in both boys and girls.
Higher fat and lean body mass also were independently associated with better bone mass outcomes in the children, Dr. Arpadi affirmed. “The use of bone friendly drugs may be beneficial for bone health in children with HIV,” he concluded.
The study was supported by the National Institutes of Health. Dr. Arpadi reported no conflicts of interest.
On Twitter @richpizzi
AT CROI 2016
Key clinical point: Switching HIV-infected children from ritonavir-boosted lopinavir to efavirenz-based antiretroviral therapy may increase bone mass.
Major finding: The Bone Mineral Content Z score was –0.49 in the EFV group and –1.07 in the LPV/r group, and the association remained significant (P less than .001) and of a similar magnitude (Z-score difference, 0.58) after adjustment for age, fat mass, lean mass, vigorous physical activity, dietary vitamin D and calcium, CD4, and viral load.
Data source: A randomized clinical trial of 220 HIV-infected children aged 5-10 years (mean 6.4 years) enrolled 1-4 years (mean 2.1 years) after randomization in the trial, and 180 similarly-aged HIV-uninfected children at the same site for comparison. Among HIV-infected children, 110 were on EFV and 110 LPV/r at the time of assessment.
Disclosures: The study was supported by the National Institutes of Health. Dr. Arpadi reported no conflicts of interest.
HIV research update: Early February 2016
A great volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
Johns Hopkins recently received approval from the United Network for Organ Sharing to be the first hospital in the United States to accomplish HIV-positive to HIV-positive organ transplants. The institution will be the first in the nation to conduct an HIV-positive to HIV-positive kidney transplant and the first in the world to perform an HIV-positive to HIV-positive liver transplant.
A new study in Clinical Infectious Diseases suggests that the currently recommended dose of atovaquone 750 mg twice daily for treatment of mild-moderate Pneumocystis jirovecii pneumonia may not be adequate in HIV-infected patients receiving concurrent efavirenz.
Researchers have identified the mechanism of a potential HIV drug target, which could be a more cost-effective option than currently used HIV drugs. They found that the nucleoside 5-azacytidine (5-aza-C) blocks HIV’s ability to spread by first converting to a DNA form (5-aza-deoxyC). The DNA conversion allows 5-aza-C to infiltrate HIV when the virus turns RNA into DNA, and therefore stops the virus from replicating.
According to new research, extracts of the medicinal plant Cistus incanus attack HIV and Ebola virus particles and prevent them from multiplying in cultured cells. Because the antiviral activity of Cistus extracts differs from all clinically approved drugs, the researchers say Cistus-derived products could be an important complement to currently established drug regimens.
A study in the Journal of Leukocyte Biology suggests that a new therapeutic strategy for HIV may already be available by repurposing an existing prescription drug. An enzyme called adenosine deaminase, or ADA, ultimately may be able to activate the immune system against HIV and to help the immune system remember the virus to prevent or quickly eliminate future infection.
Researchers affiliated with the North American AIDS Cohort Collaboration on Research and Design reported in a new study a significantly higher median body mass index (BMI) after 3 years of antiretroviral therapy for HIV-infected white women, compared with age-matched, non-infected white women. The high prevalence of obesity observed among ART-exposed HIV-infected adults in North America may contribute to health complications in the future, they said.
A research project at the University of Copenhagen shows that the so-called ILCs (innate lymphoid cells) are severely depleted in patients infected with HIV-1. The study found that ILC numbers were preserved by antiretroviral therapy (ART), but only if initiated during acute infection. If treatment is initiated during the later chronic infection stage – as in current standard procedure – the ILCs are eradicated.
A recent study in the Journal of Clinical Investigation evaluated the effect of antiretroviral therapy (ART) on HIV levels in the female reproductive tract and cervicovaginal secretions (CVS), and demonstrated that ART can efficiently suppress cell-free HIV-RNA in CVS, despite residual levels of HIV-RNA-positive cells in both the female reproductive tract and CVS.
Patients with HIV and tuberculosis in eastern Europe have a risk of death nearly four times higher than that in patients from western Europe and Latin America, according to a study in the Lancet HIV. This increased mortality rate is associated with modifiable risk factors such as lack of drug susceptibility testing and suboptimal initial anti-tuberculosis treatment in settings with a high prevalence of drug resistance.
Reducing the number of men who go to prison could help curb the spread of HIV and other sexually transmitted infections in a community, according to research published in Social Science & Medicine. A computer model developed by researchers at the University of Michigan suggests that reducing incarceration in a community also may reduce the number of sexual partners men and women have, therefore reducing the spread of sexually transmitted infections.
European researchers undertook the first study to investigate immunogenetic variations that might account for human papillomavirus (HPV) susceptibility and the largest to date to categorize the HPV types in HIV warts. They analyzed the human leukocyte antigen (HLA) Class I and II allele distribution in antiretroviral (ART)-treated HIV-infected patients with persistent warts, noninfected controls, and HIV-infected controls, finding that HLA immunogenotype determines persistent HPV infection in ART-treated HIV.
According to a report in the Journal of Infectious Diseases, elevated soluble CD14 (sCD14) concentrations serve as an independent biomarker for the risk of mother-to-child transmission of HIV in a setting of pre-exposure and postexposure antiretroviral prophylaxis.
On Twitter @richpizzi
A great volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
Johns Hopkins recently received approval from the United Network for Organ Sharing to be the first hospital in the United States to accomplish HIV-positive to HIV-positive organ transplants. The institution will be the first in the nation to conduct an HIV-positive to HIV-positive kidney transplant and the first in the world to perform an HIV-positive to HIV-positive liver transplant.
A new study in Clinical Infectious Diseases suggests that the currently recommended dose of atovaquone 750 mg twice daily for treatment of mild-moderate Pneumocystis jirovecii pneumonia may not be adequate in HIV-infected patients receiving concurrent efavirenz.
Researchers have identified the mechanism of a potential HIV drug target, which could be a more cost-effective option than currently used HIV drugs. They found that the nucleoside 5-azacytidine (5-aza-C) blocks HIV’s ability to spread by first converting to a DNA form (5-aza-deoxyC). The DNA conversion allows 5-aza-C to infiltrate HIV when the virus turns RNA into DNA, and therefore stops the virus from replicating.
According to new research, extracts of the medicinal plant Cistus incanus attack HIV and Ebola virus particles and prevent them from multiplying in cultured cells. Because the antiviral activity of Cistus extracts differs from all clinically approved drugs, the researchers say Cistus-derived products could be an important complement to currently established drug regimens.
A study in the Journal of Leukocyte Biology suggests that a new therapeutic strategy for HIV may already be available by repurposing an existing prescription drug. An enzyme called adenosine deaminase, or ADA, ultimately may be able to activate the immune system against HIV and to help the immune system remember the virus to prevent or quickly eliminate future infection.
Researchers affiliated with the North American AIDS Cohort Collaboration on Research and Design reported in a new study a significantly higher median body mass index (BMI) after 3 years of antiretroviral therapy for HIV-infected white women, compared with age-matched, non-infected white women. The high prevalence of obesity observed among ART-exposed HIV-infected adults in North America may contribute to health complications in the future, they said.
A research project at the University of Copenhagen shows that the so-called ILCs (innate lymphoid cells) are severely depleted in patients infected with HIV-1. The study found that ILC numbers were preserved by antiretroviral therapy (ART), but only if initiated during acute infection. If treatment is initiated during the later chronic infection stage – as in current standard procedure – the ILCs are eradicated.
A recent study in the Journal of Clinical Investigation evaluated the effect of antiretroviral therapy (ART) on HIV levels in the female reproductive tract and cervicovaginal secretions (CVS), and demonstrated that ART can efficiently suppress cell-free HIV-RNA in CVS, despite residual levels of HIV-RNA-positive cells in both the female reproductive tract and CVS.
Patients with HIV and tuberculosis in eastern Europe have a risk of death nearly four times higher than that in patients from western Europe and Latin America, according to a study in the Lancet HIV. This increased mortality rate is associated with modifiable risk factors such as lack of drug susceptibility testing and suboptimal initial anti-tuberculosis treatment in settings with a high prevalence of drug resistance.
Reducing the number of men who go to prison could help curb the spread of HIV and other sexually transmitted infections in a community, according to research published in Social Science & Medicine. A computer model developed by researchers at the University of Michigan suggests that reducing incarceration in a community also may reduce the number of sexual partners men and women have, therefore reducing the spread of sexually transmitted infections.
European researchers undertook the first study to investigate immunogenetic variations that might account for human papillomavirus (HPV) susceptibility and the largest to date to categorize the HPV types in HIV warts. They analyzed the human leukocyte antigen (HLA) Class I and II allele distribution in antiretroviral (ART)-treated HIV-infected patients with persistent warts, noninfected controls, and HIV-infected controls, finding that HLA immunogenotype determines persistent HPV infection in ART-treated HIV.
According to a report in the Journal of Infectious Diseases, elevated soluble CD14 (sCD14) concentrations serve as an independent biomarker for the risk of mother-to-child transmission of HIV in a setting of pre-exposure and postexposure antiretroviral prophylaxis.
On Twitter @richpizzi
A great volume of HIV and AIDS research enters the medical literature every month. It’s difficult to monitor everything, so here’s a quick look at some notable news items and journal articles published over the past few weeks.
Johns Hopkins recently received approval from the United Network for Organ Sharing to be the first hospital in the United States to accomplish HIV-positive to HIV-positive organ transplants. The institution will be the first in the nation to conduct an HIV-positive to HIV-positive kidney transplant and the first in the world to perform an HIV-positive to HIV-positive liver transplant.
A new study in Clinical Infectious Diseases suggests that the currently recommended dose of atovaquone 750 mg twice daily for treatment of mild-moderate Pneumocystis jirovecii pneumonia may not be adequate in HIV-infected patients receiving concurrent efavirenz.
Researchers have identified the mechanism of a potential HIV drug target, which could be a more cost-effective option than currently used HIV drugs. They found that the nucleoside 5-azacytidine (5-aza-C) blocks HIV’s ability to spread by first converting to a DNA form (5-aza-deoxyC). The DNA conversion allows 5-aza-C to infiltrate HIV when the virus turns RNA into DNA, and therefore stops the virus from replicating.
According to new research, extracts of the medicinal plant Cistus incanus attack HIV and Ebola virus particles and prevent them from multiplying in cultured cells. Because the antiviral activity of Cistus extracts differs from all clinically approved drugs, the researchers say Cistus-derived products could be an important complement to currently established drug regimens.
A study in the Journal of Leukocyte Biology suggests that a new therapeutic strategy for HIV may already be available by repurposing an existing prescription drug. An enzyme called adenosine deaminase, or ADA, ultimately may be able to activate the immune system against HIV and to help the immune system remember the virus to prevent or quickly eliminate future infection.
Researchers affiliated with the North American AIDS Cohort Collaboration on Research and Design reported in a new study a significantly higher median body mass index (BMI) after 3 years of antiretroviral therapy for HIV-infected white women, compared with age-matched, non-infected white women. The high prevalence of obesity observed among ART-exposed HIV-infected adults in North America may contribute to health complications in the future, they said.
A research project at the University of Copenhagen shows that the so-called ILCs (innate lymphoid cells) are severely depleted in patients infected with HIV-1. The study found that ILC numbers were preserved by antiretroviral therapy (ART), but only if initiated during acute infection. If treatment is initiated during the later chronic infection stage – as in current standard procedure – the ILCs are eradicated.
A recent study in the Journal of Clinical Investigation evaluated the effect of antiretroviral therapy (ART) on HIV levels in the female reproductive tract and cervicovaginal secretions (CVS), and demonstrated that ART can efficiently suppress cell-free HIV-RNA in CVS, despite residual levels of HIV-RNA-positive cells in both the female reproductive tract and CVS.
Patients with HIV and tuberculosis in eastern Europe have a risk of death nearly four times higher than that in patients from western Europe and Latin America, according to a study in the Lancet HIV. This increased mortality rate is associated with modifiable risk factors such as lack of drug susceptibility testing and suboptimal initial anti-tuberculosis treatment in settings with a high prevalence of drug resistance.
Reducing the number of men who go to prison could help curb the spread of HIV and other sexually transmitted infections in a community, according to research published in Social Science & Medicine. A computer model developed by researchers at the University of Michigan suggests that reducing incarceration in a community also may reduce the number of sexual partners men and women have, therefore reducing the spread of sexually transmitted infections.
European researchers undertook the first study to investigate immunogenetic variations that might account for human papillomavirus (HPV) susceptibility and the largest to date to categorize the HPV types in HIV warts. They analyzed the human leukocyte antigen (HLA) Class I and II allele distribution in antiretroviral (ART)-treated HIV-infected patients with persistent warts, noninfected controls, and HIV-infected controls, finding that HLA immunogenotype determines persistent HPV infection in ART-treated HIV.
According to a report in the Journal of Infectious Diseases, elevated soluble CD14 (sCD14) concentrations serve as an independent biomarker for the risk of mother-to-child transmission of HIV in a setting of pre-exposure and postexposure antiretroviral prophylaxis.
On Twitter @richpizzi
Study: Hospitals with EHRs reduce patient harm
Cardiovascular, surgery, and pneumonia patients at hospitals with a fully electronic health record (EHR) system experienced lower rates of in-hospital adverse events, according to a new study published in the Journal of Patient Safety.
A research team led by Dr. Mark L. Metersky, medical director at the UConn Health Center for Bronchiectasis Care in Farmington, Conn., conducted a retrospective analysis of patient discharges using data from the 2012 and 2013 Medicare Patient Safety Monitoring System.
The study sample included patients aged 18 years and older that were hospitalized for one of three conditions: acute cardiovascular disease, pneumonia, or conditions requiring surgery. The main outcome measures were in-hospital adverse events, including hospital-acquired infections, adverse drug events (based on selected medications), general events, and post-procedural events.
Among the 45,235 patients who were at risk for 347,281 adverse events in the study sample, the occurrence rate of adverse events was 2.3%, and 13% of patients were exposed to a fully electronic EHR. In multivariate modeling adjusted for patient and hospital characteristics, investigators discovered that patient exposure to a fully electronic EHR was associated with 17%-30% lower odds of any adverse event for cardiovascular, pneumonia, and surgery patients.
“Beyond the direct effects on safety, EHRs can also indirectly reduce overall adverse event rates by enabling quality improvement initiatives,” said Dr. Metersky and his coauthors.
Read the full study in the Journal of Patient Safety (2016 Feb 6. doi: 10.1097/PTS.0000000000000257).
On Twitter @richpizzi
Cardiovascular, surgery, and pneumonia patients at hospitals with a fully electronic health record (EHR) system experienced lower rates of in-hospital adverse events, according to a new study published in the Journal of Patient Safety.
A research team led by Dr. Mark L. Metersky, medical director at the UConn Health Center for Bronchiectasis Care in Farmington, Conn., conducted a retrospective analysis of patient discharges using data from the 2012 and 2013 Medicare Patient Safety Monitoring System.
The study sample included patients aged 18 years and older that were hospitalized for one of three conditions: acute cardiovascular disease, pneumonia, or conditions requiring surgery. The main outcome measures were in-hospital adverse events, including hospital-acquired infections, adverse drug events (based on selected medications), general events, and post-procedural events.
Among the 45,235 patients who were at risk for 347,281 adverse events in the study sample, the occurrence rate of adverse events was 2.3%, and 13% of patients were exposed to a fully electronic EHR. In multivariate modeling adjusted for patient and hospital characteristics, investigators discovered that patient exposure to a fully electronic EHR was associated with 17%-30% lower odds of any adverse event for cardiovascular, pneumonia, and surgery patients.
“Beyond the direct effects on safety, EHRs can also indirectly reduce overall adverse event rates by enabling quality improvement initiatives,” said Dr. Metersky and his coauthors.
Read the full study in the Journal of Patient Safety (2016 Feb 6. doi: 10.1097/PTS.0000000000000257).
On Twitter @richpizzi
Cardiovascular, surgery, and pneumonia patients at hospitals with a fully electronic health record (EHR) system experienced lower rates of in-hospital adverse events, according to a new study published in the Journal of Patient Safety.
A research team led by Dr. Mark L. Metersky, medical director at the UConn Health Center for Bronchiectasis Care in Farmington, Conn., conducted a retrospective analysis of patient discharges using data from the 2012 and 2013 Medicare Patient Safety Monitoring System.
The study sample included patients aged 18 years and older that were hospitalized for one of three conditions: acute cardiovascular disease, pneumonia, or conditions requiring surgery. The main outcome measures were in-hospital adverse events, including hospital-acquired infections, adverse drug events (based on selected medications), general events, and post-procedural events.
Among the 45,235 patients who were at risk for 347,281 adverse events in the study sample, the occurrence rate of adverse events was 2.3%, and 13% of patients were exposed to a fully electronic EHR. In multivariate modeling adjusted for patient and hospital characteristics, investigators discovered that patient exposure to a fully electronic EHR was associated with 17%-30% lower odds of any adverse event for cardiovascular, pneumonia, and surgery patients.
“Beyond the direct effects on safety, EHRs can also indirectly reduce overall adverse event rates by enabling quality improvement initiatives,” said Dr. Metersky and his coauthors.
Read the full study in the Journal of Patient Safety (2016 Feb 6. doi: 10.1097/PTS.0000000000000257).
On Twitter @richpizzi
FROM THE JOURNAL OF PATIENT SAFETY
Borrelia mayonii is new cause of Lyme disease variant
A new species of Borrelia has been linked to a variant of Lyme disease with symptoms that differ somewhat from typical Lyme borreliosis.
Of 100,545 routine clinical specimens tested at the Mayo Clinic in Rochester, Minn., for Lyme borreliosis between 2003 and 2014, six clinical specimens – all from 2012 or later – yielded an atypical oppA1 PCR result, according to a study published in Lancet Infectious Diseases.
In patients with specimens yielding atypical results, medical records were reviewed and additional samples were examined by a research team led by Dr. Bobbi Pritt of Mayo Clinic.
The researchers performed DNA sequencing, microscopy, or culturing of the diagnostic specimens (five blood and one synovial), as well as oppA1 PCR testing of Ixodes scapularis ticks (black-legged or “deer” ticks) from regions of suspected patient tick exposure. Among the five blood specimens tested, the median oppA1 copy number was 180 times higher than that found in 13 specimens testing positive for B. burgdorferi during the same time period.
Multigene sequencing identified the spirochete as a novel B. burgdorferi genospecies – the same genospecies detected in ticks collected at a probable patient exposure site.
The newly discovered bacteria, provisionally named Borrelia mayonii, caused Lyme disease with symptoms similar to those caused by B. burgdorferi, but with some distinct clinical features. Similar to classic Lyme disease, fever, headache, rash, and neck pain were experienced in the early stages of infection (days after exposure) and arthritis in the later stages (weeks after exposure). But patients infected with B. mayonii also presented with nausea and vomiting, diffuse rashes (as opposed to the typical “bull’s-eye” rash), and a higher concentration of bacteria in the blood.
“In view of the differing clinical manifestations for patients infected with the novel B. burgdorferi sensu lato genospecies, it is likely that Lyme borreliosis is not being considered – and therefore not diagnosed – in some patients with this infection,” said Dr. Pritt and her colleagues. They added that the clinical range of illness must be better defined in additional patients to ensure the infection is recognized and distinguished from other tick-borne infections, and oppA1 PCR is used for diagnosing infection with B. mayonii.
Read the full study in Lancet Infectious Diseases (doi: 10.1016/S1473-3099[15]00464-8).
On Twitter @richpizzi
A new species of Borrelia has been linked to a variant of Lyme disease with symptoms that differ somewhat from typical Lyme borreliosis.
Of 100,545 routine clinical specimens tested at the Mayo Clinic in Rochester, Minn., for Lyme borreliosis between 2003 and 2014, six clinical specimens – all from 2012 or later – yielded an atypical oppA1 PCR result, according to a study published in Lancet Infectious Diseases.
In patients with specimens yielding atypical results, medical records were reviewed and additional samples were examined by a research team led by Dr. Bobbi Pritt of Mayo Clinic.
The researchers performed DNA sequencing, microscopy, or culturing of the diagnostic specimens (five blood and one synovial), as well as oppA1 PCR testing of Ixodes scapularis ticks (black-legged or “deer” ticks) from regions of suspected patient tick exposure. Among the five blood specimens tested, the median oppA1 copy number was 180 times higher than that found in 13 specimens testing positive for B. burgdorferi during the same time period.
Multigene sequencing identified the spirochete as a novel B. burgdorferi genospecies – the same genospecies detected in ticks collected at a probable patient exposure site.
The newly discovered bacteria, provisionally named Borrelia mayonii, caused Lyme disease with symptoms similar to those caused by B. burgdorferi, but with some distinct clinical features. Similar to classic Lyme disease, fever, headache, rash, and neck pain were experienced in the early stages of infection (days after exposure) and arthritis in the later stages (weeks after exposure). But patients infected with B. mayonii also presented with nausea and vomiting, diffuse rashes (as opposed to the typical “bull’s-eye” rash), and a higher concentration of bacteria in the blood.
“In view of the differing clinical manifestations for patients infected with the novel B. burgdorferi sensu lato genospecies, it is likely that Lyme borreliosis is not being considered – and therefore not diagnosed – in some patients with this infection,” said Dr. Pritt and her colleagues. They added that the clinical range of illness must be better defined in additional patients to ensure the infection is recognized and distinguished from other tick-borne infections, and oppA1 PCR is used for diagnosing infection with B. mayonii.
Read the full study in Lancet Infectious Diseases (doi: 10.1016/S1473-3099[15]00464-8).
On Twitter @richpizzi
A new species of Borrelia has been linked to a variant of Lyme disease with symptoms that differ somewhat from typical Lyme borreliosis.
Of 100,545 routine clinical specimens tested at the Mayo Clinic in Rochester, Minn., for Lyme borreliosis between 2003 and 2014, six clinical specimens – all from 2012 or later – yielded an atypical oppA1 PCR result, according to a study published in Lancet Infectious Diseases.
In patients with specimens yielding atypical results, medical records were reviewed and additional samples were examined by a research team led by Dr. Bobbi Pritt of Mayo Clinic.
The researchers performed DNA sequencing, microscopy, or culturing of the diagnostic specimens (five blood and one synovial), as well as oppA1 PCR testing of Ixodes scapularis ticks (black-legged or “deer” ticks) from regions of suspected patient tick exposure. Among the five blood specimens tested, the median oppA1 copy number was 180 times higher than that found in 13 specimens testing positive for B. burgdorferi during the same time period.
Multigene sequencing identified the spirochete as a novel B. burgdorferi genospecies – the same genospecies detected in ticks collected at a probable patient exposure site.
The newly discovered bacteria, provisionally named Borrelia mayonii, caused Lyme disease with symptoms similar to those caused by B. burgdorferi, but with some distinct clinical features. Similar to classic Lyme disease, fever, headache, rash, and neck pain were experienced in the early stages of infection (days after exposure) and arthritis in the later stages (weeks after exposure). But patients infected with B. mayonii also presented with nausea and vomiting, diffuse rashes (as opposed to the typical “bull’s-eye” rash), and a higher concentration of bacteria in the blood.
“In view of the differing clinical manifestations for patients infected with the novel B. burgdorferi sensu lato genospecies, it is likely that Lyme borreliosis is not being considered – and therefore not diagnosed – in some patients with this infection,” said Dr. Pritt and her colleagues. They added that the clinical range of illness must be better defined in additional patients to ensure the infection is recognized and distinguished from other tick-borne infections, and oppA1 PCR is used for diagnosing infection with B. mayonii.
Read the full study in Lancet Infectious Diseases (doi: 10.1016/S1473-3099[15]00464-8).
On Twitter @richpizzi
FROM LANCET INFECTIOUS DISEASES
