Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106409
Nicolas Veyrenche , Jacques Fourgeaud , Marianne Burgard , Slimane Allali , Julie Toubiana , Yaël Pinhas , Pierre Frange , Tiffany Guilleminot , Neil Derridj , Jérémie F. Cohen , Marianne Leruez-Ville
Background
A Parvovirus B19 (B19V) outbreak has been reported in Europe in 2023–2024. The aims of this study were 1) to describe the incidence of primary cases from 2012 to 2024 in one French hospital 2) to analyze the genome of 2023 strains 3) to identify virological profiles according to the clinical presentations of B19V infection.
Methods
The incidence of B19V primary cases was studied through an interrupted time-series analysis. Genomes of 2023 strains were sequenced in the NS1-VP1u region. Blood viral loads, IgG and IgM levels were analyzed in 158 cases according to clinical manifestations with Kruskal-Wallis test and a machine learning approach based on k-nearest neighbors.
Results
During the 2023–2024 B19V outbreak, there was an 8-time increase in the incidence of B19V infections compared with pre-pandemic levels (8.25 (95%CI: 5.79–11.76)). The 2023 strains belonged to genotype 1a and were closely related to pre-2019 strains. Blood viral loads were significantly different between clinical presentations (p<0.0001). Machine learning allowed us to classify 68.8% (95% CI: 60.9–75.9) patients into the correct clinical group.
Conclusions
The 2023–24 epidemic is probably due to the reemergence of the pre-2019 strain. The virological profiles highlighted in this study could assist in accurately interpreting virology results.
{"title":"Virological characterization of Parvovirus B19 isolated during the atypical 2023-2024 outbreak in France","authors":"Nicolas Veyrenche , Jacques Fourgeaud , Marianne Burgard , Slimane Allali , Julie Toubiana , Yaël Pinhas , Pierre Frange , Tiffany Guilleminot , Neil Derridj , Jérémie F. Cohen , Marianne Leruez-Ville","doi":"10.1016/j.jinf.2025.106409","DOIUrl":"10.1016/j.jinf.2025.106409","url":null,"abstract":"<div><h3>Background</h3><div>A Parvovirus B19 (B19V) outbreak has been reported in Europe in 2023–2024. The aims of this study were 1) to describe the incidence of primary cases from 2012 to 2024 in one French hospital 2) to analyze the genome of 2023 strains 3) to identify virological profiles according to the clinical presentations of B19V infection.</div></div><div><h3>Methods</h3><div>The incidence of B19V primary cases was studied through an interrupted time-series analysis. Genomes of 2023 strains were sequenced in the NS1-VP1u region. Blood viral loads, IgG and IgM levels were analyzed in 158 cases according to clinical manifestations with Kruskal-Wallis test and a machine learning approach based on k-nearest neighbors.</div></div><div><h3>Results</h3><div>During the 2023–2024 B19V outbreak, there was an 8-time increase in the incidence of B19V infections compared with pre-pandemic levels (8.25 (95%CI: 5.79–11.76)). The 2023 strains belonged to genotype 1a and were closely related to pre-2019 strains. Blood viral loads were significantly different between clinical presentations (p<0.0001). Machine learning allowed us to classify 68.8% (95% CI: 60.9–75.9) patients into the correct clinical group.</div></div><div><h3>Conclusions</h3><div>The 2023–24 epidemic is probably due to the reemergence of the pre-2019 strain. The virological profiles highlighted in this study could assist in accurately interpreting virology results.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106409"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106391
Nicole L. Henriksen , Peter Ø. Jensen , Louise K. Jensen
Immune checkpoint inhibitors designed to reinvigorate immune responses suppressed by cancer cells have revolutionized cancer therapy. Similarities in immune dysregulation between cancer and infectious diseases have prompted investigations into the role of immune checkpoints in infectious diseases, including the therapeutic potential of immune checkpoint blockade and drug repurposing. While most research has centered around viral infections, data for bacterial infections are emerging. This systematic review reports on the in vivo effect of immune checkpoint blockade on bacterial burden and selected immune responses in preclinical studies of bacterial infection, aiming to assess if there could be a rationale for using immunotherapy for bacterial infections. Of the 42 analyzed studies, immune checkpoint blockade reduced the bacterial burden in 60% of studies, had no effect in 28% and increased the bacterial burden in 12%. Findings suggest that the effect of immune checkpoint blockade on bacterial burden is context-dependent and in part relates to the pathogen. Further preclinical research is required to understand how the therapeutic effect of immune checkpoint blockade is mediated in different bacterial infections, and if immune checkpoint blockade can be used as an adjuvant to conventional infection management strategies.
{"title":"Immune checkpoint blockade in experimental bacterial infections","authors":"Nicole L. Henriksen , Peter Ø. Jensen , Louise K. Jensen","doi":"10.1016/j.jinf.2024.106391","DOIUrl":"10.1016/j.jinf.2024.106391","url":null,"abstract":"<div><div>Immune checkpoint inhibitors designed to reinvigorate immune responses suppressed by cancer cells have revolutionized cancer therapy. Similarities in immune dysregulation between cancer and infectious diseases have prompted investigations into the role of immune checkpoints in infectious diseases, including the therapeutic potential of immune checkpoint blockade and drug repurposing. While most research has centered around viral infections, data for bacterial infections are emerging. This systematic review reports on the in vivo effect of immune checkpoint blockade on bacterial burden and selected immune responses in preclinical studies of bacterial infection, aiming to assess if there could be a rationale for using immunotherapy for bacterial infections. Of the 42 analyzed studies, immune checkpoint blockade reduced the bacterial burden in 60% of studies, had no effect in 28% and increased the bacterial burden in 12%. Findings suggest that the effect of immune checkpoint blockade on bacterial burden is context-dependent and in part relates to the pathogen. Further preclinical research is required to understand how the therapeutic effect of immune checkpoint blockade is mediated in different bacterial infections, and if immune checkpoint blockade can be used as an adjuvant to conventional infection management strategies.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106391"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106383
Min Chen , Yanling Ma , Huichao Chen, Jie Dai, Lijuan Dong, Manhong Jia, Wenfei Ding
{"title":"Characterization of the first unambiguous HIV-1 CRF07_BC/CRF08_BC circulating recombinant form (CRF160_0708) in Yunnan, China","authors":"Min Chen , Yanling Ma , Huichao Chen, Jie Dai, Lijuan Dong, Manhong Jia, Wenfei Ding","doi":"10.1016/j.jinf.2024.106383","DOIUrl":"10.1016/j.jinf.2024.106383","url":null,"abstract":"","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106383"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Distributions of plasmidic genes encoding extended-spectrum and AmpC β-lactamases, and susceptibilities of global non-carbapenemase-producing meropenem-resistant Enterobacterales to ceftazidime-avibactam, meropenem-vaborbactam, and aztreonam-avibactam, 2017–2022","authors":"Shio-Shin Jean , Hou-Tai Chang , Chao-Lin Huang , I.-Min Liu, Po-Chuen Hsieh, Po-Ren Hsueh","doi":"10.1016/j.jinf.2024.106380","DOIUrl":"10.1016/j.jinf.2024.106380","url":null,"abstract":"","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106380"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106413
Alessandra Romero-Ramirez , Anushri Somasundaran , Konstantina Kontogianni , Jacob Parkes , Yusra Hussain , Susan Gould , Christopher T. Williams , Dominic Wooding , Richard Body , Hayley E. Hardwick , J. Kenneth Baillie , Jake Dunning , Malcolm G. Semple , CONDOR steering group, ISARIC 4C Investigators, Tom E. Fletcher , Thomas Edwards , Devy Emperador , Ana I. Cubas-Atienzar
Objectives
Evaluation of diagnostic accuracy of two point-of-care (POC) molecular diagnostic tests for the detection of monkeypox virus (MPXV): Xpert® Mpox (Cepheid, Inc., USA) and STANDARD™ M10 MPX/OPX (SD Biosensor, Inc., Korea).
Methods
Diagnostic accuracy of both POC platforms was evaluated using 53 upper-respiratory swabs (URS) and 32 skin lesions swabs (SS) collected from mpox and COVID-19 patients in the UK against the Sansure (Sansure Biotech Inc.) and CDC reference qPCR tests. The analytical sensitivity of both platforms was assessed using a viral isolate from II, B.1 lineage.
Results
The overall sensitivity and specificity of the Xpert® Mpox was 97.67% [95% CI 87.71–99.94%] and 88.57% [95% CI 73.26–96.80%] and 97.44% [95% CI 86.52–99.94%] and 74.42% [95% CI 58.83–86.48%] comparing the Sansure and CDC qPCR, respectively and for the M10 MPX/OPX was 87.80% [95% CI 73.80–95.92%] and 76.60% [95% CI 61.97–87.70%] and 94.29% [95% CI 80.84–99.30%] and 86.67% [95% CI 73.21–94.95%] with the Sansure and CDC qPCR.
Conclusion
The Xpert® Mpox had good diagnostic accuracy for both sample types while the M10 MPX/OPX clinical accuracy was deficient with URS. Our data supports the use of URS during the first 3 days of symptoms onset for mpox diagnosis.
目的：评价两种即时护理（POC）分子诊断检测猴痘病毒（MPXV）的诊断准确性：Xpert®Mpox （Cepheid, Inc.，美国）和STANDARD™M10 MPX/OPX （SD Biosensor, Inc.，韩国）。方法：使用从英国mpox和COVID-19患者中采集的53份上呼吸道拭子（URS）和32份皮肤病变拭子（SS），对照Sansure （Sansure Biotech Inc.）和CDC参考qPCR检测，对两种POC平台的诊断准确性进行评估。使用来自II、B.1谱系的病毒分离物评估两种平台的分析敏感性。结果：与Sansure和CDC qPCR相比，Xpert®Mpox的总体敏感性和特异性分别为97.67% [95% CI 87.71-99.94%]和88.57% [95% CI 73.26-96.80%]和97.44% [95% CI 86.52-99.94%]和74.42% [95% CI 58.83-86.48%]， M10 MPX/OPX与Sansure和CDC qPCR相比，总体敏感性和特异性分别为87.80% [95% CI 73.80-95.92%]和76.60% [95% CI 61.97-87.70%]和94.29% [95% CI 80.84-99.30%]和86.67% [95% CI 73.21-94.95%]。结论：Xpert®Mpox对两种样品类型均具有良好的诊断准确性，而M10 MPX/OPX对URS的临床准确性不足。我们的数据支持在出现症状的前3天使用尿路检查进行痘诊断。
{"title":"Evaluation of the diagnostic accuracy of Xpert® Mpox and STANDARD™ M10 MPX/OPX for the detection of monkeypox virus","authors":"Alessandra Romero-Ramirez , Anushri Somasundaran , Konstantina Kontogianni , Jacob Parkes , Yusra Hussain , Susan Gould , Christopher T. Williams , Dominic Wooding , Richard Body , Hayley E. Hardwick , J. Kenneth Baillie , Jake Dunning , Malcolm G. Semple , CONDOR steering group, ISARIC 4C Investigators, Tom E. Fletcher , Thomas Edwards , Devy Emperador , Ana I. Cubas-Atienzar","doi":"10.1016/j.jinf.2025.106413","DOIUrl":"10.1016/j.jinf.2025.106413","url":null,"abstract":"<div><h3>Objectives</h3><div>Evaluation of diagnostic accuracy of two point-of-care (POC) molecular diagnostic tests for the detection of monkeypox virus (MPXV): Xpert® Mpox (Cepheid, Inc., USA) and STANDARD™ M10 MPX/OPX (SD Biosensor, Inc., Korea).</div></div><div><h3>Methods</h3><div>Diagnostic accuracy of both POC platforms was evaluated using 53 upper-respiratory swabs (URS) and 32 skin lesions swabs (SS) collected from mpox and COVID-19 patients in the UK against the Sansure (Sansure Biotech Inc.) and CDC reference qPCR tests. The analytical sensitivity of both platforms was assessed using a viral isolate from II, B.1 lineage.</div></div><div><h3>Results</h3><div>The overall sensitivity and specificity of the Xpert® Mpox was 97.67% [95% CI 87.71–99.94%] and 88.57% [95% CI 73.26–96.80%] and 97.44% [95% CI 86.52–99.94%] and 74.42% [95% CI 58.83–86.48%] comparing the Sansure and CDC qPCR, respectively and for the M10 MPX/OPX was 87.80% [95% CI 73.80–95.92%] and 76.60% [95% CI 61.97–87.70%] and 94.29% [95% CI 80.84–99.30%] and 86.67% [95% CI 73.21–94.95%] with the Sansure and CDC qPCR.</div></div><div><h3>Conclusion</h3><div>The Xpert® Mpox had good diagnostic accuracy for both sample types while the M10 MPX/OPX clinical accuracy was deficient with URS. Our data supports the use of URS during the first 3 days of symptoms onset for mpox diagnosis.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106413"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106328
Clare Thakker , Clare Warrell , Jessica Barrett , Helen L. Booth , Peter L. Chiodini , Sylviane Defres , Jane Falconer , Nathan Jacobs , Jayne Jones , Jonathan Lambert , Clare Leong , Angela McBride , Elinor Moore , Tara Moshiri , Laura E. Nabarro , Geraldine O’Hara , Neil Stone , Clare van Halsema , Anna M. Checkley , On behalf of the British Infection Association
Eosinophilia is a common finding in returning travellers, migrants and other travelling groups. In this setting, it often indicates an underlying helminth infection. Infections associated with eosinophilia are frequently either asymptomatic or associated with non-specific symptoms but some can cause severe disease. Here the British Infection Association guidelines group has comprehensively reviewed and updated the UK recommendations for the investigation and management of eosinophilia in returning travellers, migrants and other relevant groups, first published in 2010.1 Literature reviews have been undertaken to update the evidence on the prevalence and causes of eosinophilia in these groups and on the treatment of relevant pathogens and clinical conditions. Diagnostic tests available to UK-based clinicians are summarised.
Changes made to the guidelines include updates in the sections on the investigation and empirical treatment of asymptomatic eosinophilia and on the treatment of trichuriasis, lymphatic filariasis, onchocerciasis, hookworm, fascioliasis and taeniasis. Pathogens which are rarely encountered in UK practice have been removed from the guidelines and others added, including an expanded section on fungal infection. A section on off-license and rarely used drugs has been included.
{"title":"UK guidelines for the investigation and management of eosinophilia in returning travellers and migrants","authors":"Clare Thakker , Clare Warrell , Jessica Barrett , Helen L. Booth , Peter L. Chiodini , Sylviane Defres , Jane Falconer , Nathan Jacobs , Jayne Jones , Jonathan Lambert , Clare Leong , Angela McBride , Elinor Moore , Tara Moshiri , Laura E. Nabarro , Geraldine O’Hara , Neil Stone , Clare van Halsema , Anna M. Checkley , On behalf of the British Infection Association","doi":"10.1016/j.jinf.2024.106328","DOIUrl":"10.1016/j.jinf.2024.106328","url":null,"abstract":"<div><div>Eosinophilia is a common finding in returning travellers, migrants and other travelling groups. In this setting, it often indicates an underlying helminth infection. Infections associated with eosinophilia are frequently either asymptomatic or associated with non-specific symptoms but some can cause severe disease. Here the British Infection Association guidelines group has comprehensively reviewed and updated the UK recommendations for the investigation and management of eosinophilia in returning travellers, migrants and other relevant groups, first published in 2010.<span><span><sup>1</sup></span></span> Literature reviews have been undertaken to update the evidence on the prevalence and causes of eosinophilia in these groups and on the treatment of relevant pathogens and clinical conditions. Diagnostic tests available to UK-based clinicians are summarised.</div><div>Changes made to the guidelines include updates in the sections on the investigation and empirical treatment of asymptomatic eosinophilia and on the treatment of trichuriasis, lymphatic filariasis, onchocerciasis, hookworm, fascioliasis and taeniasis. Pathogens which are rarely encountered in UK practice have been removed from the guidelines and others added, including an expanded section on fungal infection. A section on off-license and rarely used drugs has been included.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106328"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2024.106393
Edward J.M. Monk , Sarah Foulkes , Katie Munro , Ana Atti , Jasmin Islam , Susan Hopkins , Jacqui S. Reilly , Colin S. Brown , Victoria J. Hall , SIREN Study Group
Background
Healthcare workers were at a high risk of infection early in the SARS-CoV-2 pandemic. It is uncertain to what extent occupational, household and community factors contributed, and how this changed over time. We aimed to characterise the risk factors for infection over four successive waves of the pandemic in a large, UK healthcare worker cohort (SIREN).
Methods
Participants underwent fortnightly SARS-CoV-2 PCR testing and symptom/exposure questionnaire. Attack rates and adjusted OR of infection were calculated according to participant characteristics and exposures for each wave between 1st October 2020 and 30th August 2022.
Findings
19,427 participants were included in the second wave, 20,260 in the third, 11,937 in the fourth, and 6503 in the fifth. The attack rates of infection were 9.1% (alpha), 6.6% (delta), 36.6% (omicron BA.1/2) and 15.9% (omicron BA.4/5), respectively.
Occupational risk factors were only apparent in the second wave, during which significant social distancing measures were in place. These were identified as working as a healthcare assistant, nurse or bedside therapist, and working on an inpatient ward. Occupational exposure requiring personal protective equipment was also a risk.
In subsequent waves, without social restrictions, occupational characteristics were not risk factors. Instead, living with others compared to living alone was a risk, particularly children. During the third wave (winter 2021–2022), having a colleague with COVID-19 was identified as a risk for the first time.
Interpretation
Our findings highlight clinical areas and occupational groups in which there may be scope to prevent healthcare-associated infections, particularly during winter pressures. Prospective studies targeting these are essential to establish which interventions are most effective. This study also underscores the importance of community circulation and exposures when considering healthcare workforce protection.
{"title":"Characterisation of the SARS-CoV-2 pandemic in healthcare workers within the United Kingdom: Risk factors for infection during four successive waves","authors":"Edward J.M. Monk , Sarah Foulkes , Katie Munro , Ana Atti , Jasmin Islam , Susan Hopkins , Jacqui S. Reilly , Colin S. Brown , Victoria J. Hall , SIREN Study Group","doi":"10.1016/j.jinf.2024.106393","DOIUrl":"10.1016/j.jinf.2024.106393","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare workers were at a high risk of infection early in the SARS-CoV-2 pandemic. It is uncertain to what extent occupational, household and community factors contributed, and how this changed over time. We aimed to characterise the risk factors for infection over four successive waves of the pandemic in a large, UK healthcare worker cohort (SIREN).</div></div><div><h3>Methods</h3><div>Participants underwent fortnightly SARS-CoV-2 PCR testing and symptom/exposure questionnaire. Attack rates and adjusted OR of infection were calculated according to participant characteristics and exposures for each wave between 1st October 2020 and 30th August 2022.</div></div><div><h3>Findings</h3><div>19,427 participants were included in the second wave, 20,260 in the third, 11,937 in the fourth, and 6503 in the fifth. The attack rates of infection were 9.1% (alpha), 6.6% (delta), 36.6% (omicron BA.1/2) and 15.9% (omicron BA.4/5), respectively.</div><div>Occupational risk factors were only apparent in the second wave, during which significant social distancing measures were in place. These were identified as working as a healthcare assistant, nurse or bedside therapist, and working on an inpatient ward. Occupational exposure requiring personal protective equipment was also a risk.</div><div>In subsequent waves, without social restrictions, occupational characteristics were not risk factors. Instead, living with others compared to living alone was a risk, particularly children. During the third wave (winter 2021–2022), having a colleague with COVID-19 was identified as a risk for the first time.</div></div><div><h3>Interpretation</h3><div>Our findings highlight clinical areas and occupational groups in which there may be scope to prevent healthcare-associated infections, particularly during winter pressures. Prospective studies targeting these are essential to establish which interventions are most effective. This study also underscores the importance of community circulation and exposures when considering healthcare workforce protection.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106393"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jinf.2025.106414
Tangwei Mou , Kai-Cheng Gao , Xiyao Chen , Qingyang Qian , Jing Lin , Ran Zhang , Jing Yang , Peipei Qu , Guozhong Zhou , Yi-Qun Kuang
Background
Antiretroviral therapy (ART) has significantly improved outcomes for people living with HIV (PLWH), but poor CD4+ T-cell recovery remains a challenge. This study aimed to evaluate the relationship between poor CD4+ T-cell recovery and the morbidity of clinical events (CEs) in PLWH after ART initiation.
Methods
We conducted a comprehensive search of the EMBASE, PubMed, Web of Science, and Cochrane Library databases up to February 19, 2024, and included studies that reported the number of CEs along with the CD4 count at the time of the CEs or the most recent CD4 count prior to the CEs. A random-effects model was employed for meta-analysis to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for CEs at different CD4 count thresholds.
Findings
We included 15 studies with 54,766 PLWH and reported a significant inverse correlation between CD4+ T-cell counts and the morbidity of both AIDS-defining events (ADEs) and non-AIDS-defining infections (NADIs). However, CD4+ T-cell counts were not significantly associated with non-AIDS-defining noninfections (NADNIs). Compared with individuals with normal CD4 counts (>500 cells/μL), those with CD4 counts <200 cells/μL and 200–350 cells/μL exhibited higher ADEs morbidity, with ORs of 7·04 (95% CI: 1·77−28·03) and 1·63 (95% CI: 1·36−1·97), respectively. Similarly, individuals with CD4 counts <200 cells/μL showed a higher morbidity of NADIs (OR = 2·82, 95% CI: 1·50−5·31). However, no significant difference in NADNI morbidity was observed between groups with poor CD4+ T-cell recovery and those with normal CD4 counts.
Interpretation
This meta-analysis revealed an inverse relationship between CD4+ T-cell counts and morbidity associated with ADEs and NADIs in PLWH after ART initiation, with key thresholds of 350 cells/μL and 200 cells/μL. No significant associations were found between CD4 counts and NADNIs. These results highlight the need for comprehensive patient care that goes beyond monitoring only CD4 counts.
{"title":"Clinical events associated with poor CD4+ T-cell recovery in people living with HIV following ART: A systematic review and meta-analysis","authors":"Tangwei Mou , Kai-Cheng Gao , Xiyao Chen , Qingyang Qian , Jing Lin , Ran Zhang , Jing Yang , Peipei Qu , Guozhong Zhou , Yi-Qun Kuang","doi":"10.1016/j.jinf.2025.106414","DOIUrl":"10.1016/j.jinf.2025.106414","url":null,"abstract":"<div><h3>Background</h3><div>Antiretroviral therapy (ART) has significantly improved outcomes for people living with HIV (PLWH), but poor CD4<sup>+</sup> T-cell recovery remains a challenge. This study aimed to evaluate the relationship between poor CD4<sup>+</sup> T-cell recovery and the morbidity of clinical events (CEs) in PLWH after ART initiation.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search of the EMBASE, PubMed, Web of Science, and Cochrane Library databases up to February 19, 2024, and included studies that reported the number of CEs along with the CD4 count at the time of the CEs or the most recent CD4 count prior to the CEs. A random-effects model was employed for meta-analysis to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for CEs at different CD4 count thresholds.</div></div><div><h3>Findings</h3><div>We included 15 studies with 54,766 PLWH and reported a significant inverse correlation between CD4<sup>+</sup> T-cell counts and the morbidity of both AIDS-defining events (ADEs) and non-AIDS-defining infections (NADIs). However, CD4<sup>+</sup> T-cell counts were not significantly associated with non-AIDS-defining noninfections (NADNIs). Compared with individuals with normal CD4 counts (>500 cells/μL), those with CD4 counts <200 cells/μL and 200–350 cells/μL exhibited higher ADEs morbidity, with ORs of 7·04 (95% CI: 1·77−28·03) and 1·63 (95% CI: 1·36−1·97), respectively. Similarly, individuals with CD4 counts <200 cells/μL showed a higher morbidity of NADIs (OR = 2·82, 95% CI: 1·50−5·31). However, no significant difference in NADNI morbidity was observed between groups with poor CD4<sup>+</sup> T-cell recovery and those with normal CD4 counts.</div></div><div><h3>Interpretation</h3><div>This meta-analysis revealed an inverse relationship between CD4<sup>+</sup> T-cell counts and morbidity associated with ADEs and NADIs in PLWH after ART initiation, with key thresholds of 350 cells/μL and 200 cells/μL. No significant associations were found between CD4 counts and NADNIs. These results highlight the need for comprehensive patient care that goes beyond monitoring only CD4 counts.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"90 2","pages":"Article 106414"},"PeriodicalIF":14.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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