Clinical Infectious Diseases最新文献

This retrospective study evaluated Bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) in 24 persons with human immunodeficiency virus type 2 (HIV-2, PWHIV-2), 5 naive and 19 pretreated. After a median follow-up of 37.5 months, all PWHIV-2 had a plasma viral load <40 copies/mL. Median CD4 count increased significantly from 580 to 625 cells/mm3, suggesting the effectiveness of BIC/FTC/TAF to treat HIV-2 infection.

Data on alcohol use and incident tuberculosis (TB) infection are needed. In adults aged ≥15 in rural Uganda (N = 49 585), estimated risk of incident TB was 29.2% with alcohol use versus 19.2% without (RR: 1.49; 95%CI: 1.40-1.60). There is potential for interventions to interrupt transmission among people who drink alcohol.

Background: Tenofovir alafenamide (TAF)-based antiretroviral therapy (ART) regimens have been associated with adverse changes in lipid and glucose profiles compared with tenofovir disoproxil fumarate (TDF)-based ART, but data in pregnancy are limited. We evaluated metabolic markers in pregnant women with human immunodeficiency virus (HIV) after starting TAF- versus TDF-based ART.

Methods: We analyzed data within the IMPAACT 2010/VESTED trial, which demonstrated better pregnancy outcomes in pregnant women randomized to initiate TAF/Emtricitabine/Dolutegravir (TAF/FTC + DTG; n = 217) or TDF/FTC + DTG (n = 215). We measured non-fasting plasma concentrations of glucose, total-cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), lipoprotein (a), and triglycerides from samples collected 8 weeks after enrollment. We employed linear regression models to estimate by-arm mean differences.

Results: In total, 219 participants enrolled in the DTG arms in Zimbabwe and Uganda: 109 in the TAF/FTC + DTG and 110 in the TDF/FTC + DTG arms. At study entry, mean gestational age was 22.6 weeks, median HIV-1 RNA was 711 copies/mL, and mean age was 25.8 years. By 8 weeks, mean total cholesterol was 12 mg/dL higher in women randomized to TAF/ FTC + DTG versus TDF/FTC + DTG (95% confidence interval [CI]: 3.8, 21.1). Pregnant women in the TAF/FTC + DTG arm had higher mean LDL-C (7.1 mg/dL, 95% CI: .2, 14.0), triglycerides (12.3 mg/dL, 95% CI: 1.8, 22.7), lipoprotein (a) (7.3 mg/dL, 95% CI: 1.1, 13.6), and lower mean HDL-C (2.8 mg/dL, 95% CI: .1, 5.6) compared to the TDF/FTC + DTG arm.

Conclusions: Pregnant women randomized to start TAF/FTC + DTG had higher lipids than those randomized to TDF/FTC + DTG within 8 weeks of ART initiation. However, lipid levels were within normal reference ranges.

Background: Pregnant people are at risk of severe coronavirus disease 2019 (COVID-19) and associated complications. While withholding treatment from pregnant patients is not recommended, little is known about the frequency of antiviral medication use during pregnancy.

Methods: Using Medicaid and commercial insurance databases, we constructed a national claims-based cohort study of pregnant, recently pregnant, and nonpregnant female patients 18-49 years old with an outpatient diagnosis of COVID-19 between 21 December 2021 and 30 September 2022. Outpatient treatment with a recommended antiviral medication was identified within 5 days of diagnosis, using national drug codes in outpatient prescription drug claims. Propensity score-matched prevalence ratios (PRs) were used to compare antiviral treatment by pregnancy status.

Results: A total of 412 755 publicly and privately insured patients with COVID-19 were identified, including 33 855 currently pregnant, 2460 recently pregnant, and 376 440 nonpregnant female patients; 6.8% had a record of antiviral medication use, including 1.3% of pregnant, 5.4% of recently pregnant, and 7.3% of nonpregnant women. Most commonly ritonavir-boosted nirmatrelvir was administered. The prevalence of antiviral medication use was 67% lower among pregnant patients compared with nonpregnant patients (PR, 0.33 [95% confidence interval, .30-.36]), even among patients with ≥1 high-risk medical condition (0.29 [.25-.33]). Antiviral medication use was slightly lower among recently pregnant women with ≥1 high-risk medical condition than among nonpregnant women with similar conditions (PR, 0.57; [95% confidence interval, .44-.72]).

Conclusions: Despite US clinical guidelines, we observed low rates of outpatient treatment for COVID-19 among pregnant patients, indicating possible missed opportunities to treat COVID-19 illness during pregnancy and lactation.

Background: Data regarding the effectiveness of vancomycin resistant Enterococci (VRE) active prophylaxis for preventing early post-liver transplant (LT) VRE infections in VRE-colonized patients are scarce.

Methods: One-hundred-thirty-one pre-LT VRE colonized patients who underwent liver transplantation were enrolled in a retrospective, observational, multicenter study. The incidence of early-onset VRE infections was compared between patients who received active prophylaxis for VRE and those who did not.

Results: Sixty-nine (52.7%) and 62 (47.3%) patients were enrolled in the VRE-active and non-VRE-active prophylaxis group. Tigecycline was the most common drug prescribed as VRE-active for prophylaxis (55/69, 79.7%). There was no significant difference in the number of patients who developed early-onset VRE infections in the VRE-active vs non-VRE-active groups at 7 [0 (0.0 %) vs 2 (3.2 %), p=0.222], 14 [4 (5.7 %) vs 4 (6.4%), p=1.000] and 30 [6 (8.7%) vs. 8 (12.9%), p=0.621] days post-LT respectively. Risk of early-onset VRE infection within 30 days was not lower in the VRE-active group (log-rank p=0.16 at Kaplan-Meier analysis; OR 0.643, 95% CI 0.210-1.969, p=0.439 at univariate analysis). Conversely, early infections caused by any pathogen were significantly lower in the VRE-active prophylaxis group compared to the control group [11 (15.9%) vs. 20 (32.2%), p=0.047]. Tigecycline prophylaxis was associated with a lower risk of early-onset infections at multivariate analysis (OR 0.106, 95% CI 0.015-0.745, p=0.024) and after adjusting for propensity score (aOR 0.146, 95% CI 0.031-0.708, p=0.017).

Conclusions: VRE-active prophylaxis at LT did not reduce the incidence of early post-LT VRE infections and should not be recommended.

Background: Current U.S. COVID-19 vaccine recommendations provide guidance for adults to receive at least annual variant-targeted vaccination. We sought to estimate the strength and durability of protection from annual variant-targeted vaccination against severe COVID-19 illness in individuals with vaccine-derived and hybrid immunity.

Methods: We emulated a target trial using an electronic health record-based, propensity-score matched (1:1) cohort of U.S. Veterans. Booster vaccinated adults were eligible for a variant-targeted mRNA booster starting September 1, 2022. Matched sets of those who did and did not receive the variant-targeted booster dose were identified on a weekly basis, and the cohort was followed until August 31, 2023. Outcomes were hospitalization due to COVID-19 pneumonia, and in-hospital severe illness. We fit Cox models, overall and stratified by last documented SARS-CoV-2 infection (pre-Omicron, Omicron), to estimate relative vaccine effectiveness (VE).

Results: The propensity-score matched cohort consisted of 1,576,626 COVID-19 booster vaccinated adults. Estimates of relative vaccine effectiveness (rVE) from variant-targeted mRNA booster against hospitalization due to COVID-19 pneumonia were significant and similar in the cohort with vaccine-derived immunity (rVE: 29%; 95%CI: 25%, 34%) and cohort with hybrid immunity (rVE: 38%; 95%CI: 27%, 47%). These protective gains were significant from 0-6 but not 6-12 months after vaccination and during pre-XBB and XBB variant eras. Findings were similar for in-hospital severe illness.

Conclusion: In cohorts with vaccine-derived and hybrid immunity, modest but significant gains in protection against hospitalization and severe COVID-19 illness were conferred by the annual variant-targeted booster dose but not sustained beyond 6 months.

Background: Household transmission of respiratory viruses may drive community spread. Few recent studies have examined household respiratory syncytial virus (RSV) transmission in the United States.

Methods: We conducted a prospective community-based cohort study from 1 June 2022 to 31 May 2023. Participants had blood samples collected and completed nasal swabs and surveys at least weekly, irrespective of symptoms. We tested serum for RSV antibody, nasal swabs by quantitative reverse transcription polymerase chain reaction (RT-qPCR), and performed whole genome sequencing. We evaluated secondary RSV transmission and associated risk factors based on a log-linear Poisson regression model.

Results: RSV was detected among 310 (10%) participants within 200 (20%) households. Most (94%) index cases were symptomatic. We identified 37 cases of potential secondary transmission within 14 days of a distinct index case (10%, 95% confidence interval [CI]: 7%, 14%); median age of index and secondary cases were 6 (interquartile range [IQR]: 3-10) and 35 (7-41) years, respectively, with 89% (24/27) of index cases aged 6 months to 12 years. Factors associated with increased risk of RSV transmission included index case viral detection ≥1 week and contact age ≤12 years. Of 120 sequenced specimens, the main lineages represented were A.d.5.2 (n = 37) and A.d.1 (n = 30). Sequenced viruses from households with ≥2 RSV infections were similar when occurring within ≤14 days (mean pairwise difference 4 [range 0-13], n = 17 households), compared to those >14 days (137 [37-236], n = 2).

Conclusions: Most RSV household transmission occurs from infants and young children to adults. Viral genome sequencing demonstrated that multiple household infections within a 14-day period are likely due to within-household transmission.