Clinical Infectious Diseases最新文献

Background: Non-AIDS defining malignancies present a growing challenge for persons with human immunodeficiency virus (HIV, PWH), yet tailored interventions for timely cancer diagnosis are lacking. The Spanish IMPAC-Neo protocol was designed to compare two comprehensive cancer screening strategies integrated into routine HIV care. This study reports baseline data on the prevalence and types of precancerous lesions and early-stage cancer among participants at enrolment. Acceptability of the procedure was additionally assessed.

Methods: Cross-sectional analysis of a comprehensive screening protocol to detect precancer and cancer. The readiness of healthcare providers to implement the protocol was evaluated using a validated 4-item survey.

Results: Among the 1430 enrolled PWH, 1172 underwent 3181 screening tests, with positive findings in 29.4% of cases, leading to further investigation in 20.7%. Adherence to the protocol was 84%, with HIV providers expressing high acceptability (97.1%), appropriateness (91.4%), and feasibility (77.1%). A total of 145 lesions were identified in 109 participants, including 60 precancerous lesions in 35 patients (3.0%), 9 early-stage cancers in 9 patients (0.8%), and 76 low-risk lesions in 65 subjects (5.5%). Adverse events related to screening occurred in 0.8% of participants, all mild. The overall prevalence of cancer precursors or early-stage cancer was 3.8% (95% confidence interval [CI], 2.74%-5.01%), with highest rates observed in individuals screened for anal and colorectal cancers.

Conclusions: The baseline comprehensive cancer screening protocol of the IMPAC-Neo study successfully identified a significant proportion of PWH with precancerous lesions and early-stage cancer. High adherence rates and positive feedback from providers suggest effective implementation potential in real-world healthcare settings.

Antibiotic prophylaxis is often recommended for close contacts of index cases of invasive Streptococcus pyogenes infections. Using MarketScan data (2010-2019), we found no difference in infection rates between those who received and those who did not receive antibiotics but a 3-fold increased risk of adverse events in those who did receive antibiotics.

More than 80% of people with human immunodeficiency virus (HIV) in low- and middle-income countries (LMICs) take first-line tenofovir-disoproxil/lamivudine (or emtricitabine)/dolutegravir (TLD). Due to hard-fought activism, TLD now costs <$45 per person per year in more than 100 LMICs under Voluntary License. With final dolutegravir (DTG) patents expiring by 2029, generic TLD will soon be available globally. Here, we identify seven critical benchmarks that underpin TLDs' success which novel antiretroviral therapy (ART) should now meet, and an eighth benchmark for which novel ART should aim. These benchmarks are superior efficacy; high genetic barrier to resistance; safety in hepatitis B coinfection; favourable drug interaction profiles; HIV2 efficacy; safety in pregnancy, long-acting formulation availability and affordable pricing. We compare the generic TLD availability timeline with development timelines for two case-study novel ART combinations: islatravir/doravirine and cabotegravir/rilpivirine. We demonstrate that currently these regimens and trial programs will not meet key benchmarks required to compete with TLD.

Background: Limited evidence suggests elevated risks of cardiovascular disease (CVD) among people diagnosed with tuberculosis (TB) disease, though studies have not adjusted for preexisting CVD risk. We carried out a cohort study using 2 separate datasets, estimating CVD incidence in people with TB versus those without.

Methods: Using data from the United States (Veterans Health Administration) and the United Kingdom (Clinical Practice Research Datalink) for 2000-2020, we matched adults with incident TB disease and no CVD history 2 years before TB diagnosis (US, n = 2121; UK, n = 15 820) with up to 10 people without TB on the basis of age, sex, race/ethnicity and healthcare practice. Participants were followed beginning 2 years before TB diagnosis and for 2 years subsequently. The acute period was defined as 3 months before/after TB diagnosis. TB, CVD, and covariates were identified from electronic routinely collected data (primary and secondary care; mortality). Poisson models estimated incident rate ratios for CVD events in people with TB compared to those without.

Results: CVD incidence was consistently higher in people with TB, including during the baseline period (pre-TB) and particularly in the acute period: incident rate ratios were US, 3.5 (95% confidence interval, 2.7-4.4), and UK, 2.7 (2.2-3.3). Rate ratios remained high after adjusting for differences in preexisting CVD risk: US, 3.2 (2.2-4.4); UK, 1.6 (1.2-2.1).

Conclusions: Increased CVD incidence was observed in people with TB versus those without, especially within months of TB diagnosis, persistent after adjustment for differences in preexisting risk. Enhancing CVD screening and risk management may improve long-term outcomes in people with TB.

Healthcare for transgender and gender-diverse (TGD) patients is evolving. With 1.6 million people in the United States identifying as transgender, clinicians have significant opportunity to learn, build trust, and offer thoughtful preventive and therapeutic care. Gender-affirming care starts by using chosen names and pronouns and creating welcoming environments. Medical and surgical care for TGD persons is endorsed by multiple medical societies and is associated with reduced symptoms of dysphoria and improved quality of life. Barriers accessing this care include a lack of provider knowledge and availability, socioeconomic factors, discrimination, ongoing anti-LGBTQ+ legislation, and mistreatment from the medical system. Complications of gender-affirming surgical procedures are uncommon when performed by qualified and well-trained surgeons, though often patients must travel significant distances to attain surgical care, limiting postoperative follow-up. Complications of non-medical-grade procedures, such as fillers, are common and can present many years after the initial procedure. With respect to sexual wellness, social and biomedical interventions addressing disproportionate effects of human immunodeficiency virus and sexually transmitted infections on TGD people show promise in clinical trials. Further education for providers and patients, advocacy for affirming spaces and policies promoting evidence-based care, and building trust are crucial for holistic care of TGD patients.