Acquired Human Immunodeficiency Virus Type 1 Drug Resistance in Rhode Island, USA, 2004-2021.

BACKGROUND: Human immunodeficiency virus type 1 (HIV-1) acquired drug resistance (ADR) compromises antiretroviral therapy (ART). METHODS: We aggregated all HIV-1 protease-reverse transcriptase-integrase sequences over 2004-2021 at the largest HIV center in Rhode Island and evaluated ADR extent, trends, and impact using Stanford Database tools. Trends were measured with Mann-Kendall statistic, and multivariable regressions evaluated resistance predictors. RESULTS: Sequences were available for 914 ART-experienced persons. Overall ADR to any drug decreased from 77% to 49% (-0.66 Mann-Kendall statistic); nucleoside reverse transcriptase inhibitors 65% to 32%, nonnucleoside reverse transcriptase inhibitors 53% to 43%, and protease inhibitors 28% to 7% (2004-2021), and integrase strand transfer inhibitors 16% to 13% (2017-2021). Multiclass resistance decreased from 44% to 12% (2-class) and 12% to 6% (3-class). In 2021, 94% had at least one 3-drug or 2-drug one-pill-once-daily (OPOD) option. Males and those exposed to more ART regimens were more likely to have ≥2-class resistance, and higher regimen exposure was also associated with fewer OPOD options. CONCLUSIONS: Comprehensive analyses within a densely-sampled HIV epidemic over 2004-2021 demonstrated decreasing ADR. Continued ADR monitoring is important to maintain ART success, particularly with rising INSTI use in all lines of therapy and 2-drug and long-acting formulations.

Coupling redox flow desalination with lithium recovery from spent lithium-ion batteries.

Electrochemical redox flow desalination is an emerging method to obtain freshwater; however, the costly requirement for continuously supplying and regenerating redox species limits their practical applications. Recycling of spent lithium-ion batteries is a growing challenge for their sustainable utilization. Existing battery recycling methods often involve massive secondary pollution. Here, we demonstrate a redox flow system to couple redox flow desalination with lithium recovery from spent lithium-ion batteries. The spontaneous reaction between a battery cathode material (LiFePO4) and ferricyanide enables the continuous regeneration of the redox species required for desalination. Several critical operating parameters are optimized, including current density, the concentrations of redox species, salt concentrations of brine, and the amounts of added LiFePO4. With the addition of 0.5920 g of spent LiFePO4 in five consecutive batches, the system can operate over 24 h, achieving 70.46 % lithium recovery in the form of LiCl aqueous solution at the concentration of 6.716 g·L-1. Simultaneously, the brine (25 mL, 10000 ppm NaCl) was desalinated to freshwater. Detailed cost analysis shows that this redox flow system could generate a revenue of ¥ 13.66 per kg of processed spent lithium-ion batteries with low energy consumption (0.77 MJ kg-1) and few greenhouse gas emissions indicating excellent economic and environmental benefits over existing lithium-ion battery recycling technologies, such as pyrometallurgical and hydrometallurgical methods. This work opens a new approach to holistically addressing water and energy challenges to achieve sustainable development.

Isolated Ocular Mpox without Skin Lesions, United States.

We report a case of a 53-year-old HIV-negative patient in San Francisco, California, USA, with no classic mpox prodromal symptoms or skin lesions who experienced fulminant, vision-threatening scleritis, keratitis, and uveitis. Deep sequence analysis identified monkeypox virus RNA in the aqueous humor. We confirmed the virus on the cornea and sclera by PCR.

Double-photoelectrode redox desalination of seawater.

High energy consumption and low salt removal rate are key barriers to realizing practical electrochemical seawater desalination processes. Here, we demonstrate a novel solar-driven redox flow desalination device with double photoelectrodes to achieve efficient desalination without electrical energy consumption. The device consists of three parts: one photoanode unit, one photocathode unit, and one redox flow desalination unit sandwiched between the two photoelectrode units. The photoelectrode units include a TiO2 photoanode and a NiO photocathode sensitized with N719 dye, triiodide/iodide redox electrolyte, and graphite paper integrated electrodes decorated with 3,4-ethylene-dioxythiophene. Two salt feeds are located between two ferro/ferricyanide redox flow chambers. Under light illumination, high-quality freshwater is obtained from brackish water containing different concentrations of NaCl from 1000 to 12,000 ppm with a high NaCl removal rate. The device can work in multiple desalination cycles without significant performance declines. Furthermore, natural seawater with an ionic conductivity of 53.45 mS cm-1 is desalinated to freshwater. This new design opens opportunities to realize efficient and practical solar-driven desalination processes.

Characterization of HIV-Related Stigma in Myanmar.

Characterizing HIV-related stigma and its impacts are important for interventions toward their elimination. A cross-sectional study was conducted in 2016 to evaluate enacted and internalized stigma among adult people living with HIV (PLWH) across four cities in Myanmar using the India Stigma Index questionnaire. Multivariable regression analyses were performed to determine differences in measured enacted and internalized stigma outcomes. Among 1,006 participants, 89% reported any stigma indicator, 47% enacted stigma, and 87% internalized stigma. In regression analysis, city and duration of illness were associated with higher enacted stigma, and younger age was associated with higher internalized stigma. Those with HIV duration > 7.4 years had mean enacted stigma nearly 2 units higher than the overall mean. Internalized stigma increased with duration of illness and leveled off at 5 years. PLWH from smaller cities experienced lower stigma. In Myanmar, nearly 90% of PLWH experience stigma, results that reflect a unique transition point.

The multi-functional system of electrochemical desalination, RhB degradation and Cr (VI) removal.

SYNOPSIS: : The single function of salt removal limits the further development of the CDI system. A multi-function CDI device is proposed to achieve electrochemical desalination, organics degradation and dichromate ion removal.

High-Performance Photoelectrochemical Desalination Based on the Dye-Sensitized Bi2O3 Anode.

In this work, a solar-driven redox flow desalination system is reported, which combines a solar cell based on a Bi2O3 photoanode and a redox flow desalination cell through an integrated electrode. The Bi2O3 film was prepared through a simple one-step water bath deposition method and served as a photoanode after the coating of the N719 dye. The activated carbon (AC)-coated graphite paper served as both the integrated electrode and counter electrode. The I3-/I- redox electrolyte circulates in the solar cell channel between the photoanode and intergrated electrode, while the [Fe(CN)6]4-/[Fe(CN)6]3- electrolyte circulates in the redox flow desalination part between the integrated electrode and counter electrode. This dye-sensitized solar-driven desalination cell is capable of achieving a maximum salt removal rate of 62.89 µg/(cm2·min) without consuming any electrical power. The combination of the solar cell and redox flow desalination is highly efficient with double functions of desalination and energy release using light as a driving force. This current research work is significant for the development of efficient and stable photoanode materials in photoelectrochemical desalination.

Photo-Assisted Rechargeable Battery Desalination.

Herein, we propose a novel design of photo-assisted battery desalination, which provides the tri-function within a single device including the photo-assisted charge (electrical energy saving), energy storage, and desalination (salt removal). The photoelectrode (N719/TiO2) is directly integrated into the zinc-iodide (Zn-I) battery with the desalination stream in the middle portion of the device. This architecture can provide a reduced energy consumption up to 50%, an energy output of 42 W h mol-1NaCl, and a desalination rate of 13 µg/cm2 min-1. This work is significant for the inter-discipline study of the redox flow energy storage and energy-saving desalination.

Statewide Longitudinal Trends in Transmitted HIV-1 Drug Resistance in Rhode Island, USA.

BACKGROUND: HIV-1 transmitted drug resistance (TDR) remains a global challenge that can impact care, yet its comprehensive assessment is limited and heterogenous. We longitudinally characterized statewide TDR in Rhode Island. METHODS: Demographic and clinical data from treatment-naïve individuals were linked to protease, reverse transcriptase, and integrase sequences routinely obtained over 2004-2020. TDR extent, trends, impact on first-line regimens, and association with transmission networks were assessed using the Stanford Database, Mann-Kendall statistic, and phylogenetic tools. RESULTS: In 1123 individuals, TDR to any antiretroviral increased from 8% (2004) to 26% (2020), driven by non-nucleotide reverse transcriptase inhibitor (NNRTI; 5%-18%) and, to a lesser extent, nucleotide reverse transcriptase inhibitor (NRTI; 2%-8%) TDR. Dual- and triple-class TDR rates were low, and major integrase strand transfer inhibitor resistance was absent. Predicted intermediate to high resistance was in 77% of those with TDR, with differential suppression patterns. Among all individuals, 34% were in molecular clusters, some only with members with TDR who shared mutations. Among clustered individuals, people with TDR were more likely in small clusters. CONCLUSIONS: In a unique (statewide) assessment over 2004-2020, TDR increased; this was primarily, but not solely, driven by NNRTIs, impacting antiretroviral regimens. Limited TDR to multiclass regimens and pre-exposure prophylaxis are encouraging; however, surveillance and its integration with molecular epidemiology should continue in order to potentially improve care and prevention interventions.

Evaluation of peer-to-peer HIV counseling in Myanmar: a measure of knowledge, adherence, and barriers.

In Myanmar, an Asian country with one of the highest HIV-1 prevalence rates, counseling prior to initiating antiretroviral therapy (ART) is standard care, either by a healthcare worker (standard counselor, SC) or trained counselor who is also living with HIV (peer counselor, PC). PC is commonly utilized in Myanmar and other resource-limited settings. However, its benefit over SC is unclear. We conducted a cross-sectional survey of people living with HIV (PLWH), who completed either only PC or only SC before treatment initiation across four cities in Myanmar. Participants were evaluated for HIV knowledge, stigma, antiretroviral adherence, barriers to care, social support satisfaction and attitudes regarding both counseling processes. Bivariate analyses and multivariable mixed effects modeling were conducted to compare differences in these measures among PC and SC participants. Among 1006 participants (49% PC; 51% SC), 52% were females and median age was 37 years in those receiving PC and 40 years in those receiving SC. More than 70% of participants in both groups achieved up to grade school education. The average duration since HIV diagnosis was 4.6 years for PC and 5.7 years for SC participants. HIV knowledge and attitudes regarding counseling were good in both groups and more PC participants credited their HIV counselor for knowledge (75% vs 63%, p < 0.001). Compared to SC, PC participants had lower enacted stigma (Incidence Rate Ratio (IRR) 0.75, Confidence Interval (CI) [0.65, 0.86]), mean internalized stigma (-0.24, CI [-0.34, -0.14]), and risk of antiretroviral therapy non-adherence (Odds Ratio 0.59, CI [0.40, 0.88]), while reporting higher levels of barriers to care (9.63, CI [8.20, 11.75]). Our findings demonstrate potential benefits of PC compared to SC, and support the utilization of PC to enhance HIV health outcomes within the unique societal and geographical context of Myanmar, and possibly beyond.

Stigma Determines Antiretroviral Adherence in Adults With HIV in Myanmar.

INTRODUCTION: Understanding social and structural barriers that determine antiretroviral therapy (ART) adherence can improve care. Assessment of such factors is limited in Myanmar, a country with high HIV prevalence and increasing number of people living with HIV initiating ART. METHODS: Questionnaires were administered to adults with HIV across 4 Myanmar cities to estimate adherence and its potential determinants, including HIV knowledge, social support, barriers to care, enacted and internalized stigma, and engagement in peer-to-peer HIV counseling (PC). Associations were determined using logistic mixed-effects modeling. RESULTS: Among 956 participants, the mean age was 39 years, 52% were female, 36% had CD4 <350 cells/mm3, and 50% received pre-ART PC. Good adherence was reported by 74% of participants who had better HIV knowledge than those reporting nonadherence. Among nonadherent, 44% were forgetful and 81% were careless about taking ART. Among all participants, most (53%) were very satisfied with their social support and 79% reported lack of financial resources as barriers to care. Participants most frequently reported being viewed differently by others (30%) and feeling as if they were paying for past karma or sins because of their HIV diagnosis (66%). Enacted stigma (odds ratio 0.86; 95% confidence interval 0.79 to 0.92, P < 0.01) and internalized stigma (odds ratio 0.73; 95% confidence interval: 0.56 to 0.95, P = 0.023) were associated with worse adherence. CONCLUSIONS: Increased self-reported ART adherence in Myanmar is associated with less enacted and internalized stigma. These findings suggest the benefit of developing and promoting adherence interventions, which are focused on mitigating HIV-related stigma in the county.

Treatment of Fatty Liver Disease: The Present and the Future.

Non-alcoholic fatty liver disease (NAFLD) progressing to non-alcoholic steatohepatitis (NASH), cirrhosis, end-stage liver disease (ESRD), and hepatocellular carcinoma (HCC) is emerging as a global epidemic. Obesity, diabetes, and metabolic syndrome are some of the leading risk factors for NAFLD. The most prevalent treatment to stop the progression is aimed at dietary modification and lifestyle changes. Bariatric surgery is indicated for patients with morbid obesity with NAFLD. The progression of NAFLD to NASH and HCC can be arrested at various stages of pathogenesis by the already prevalent drugs and the emerging newer molecular and genetic targets. This review article analyzed various preclinical animal trials and clinical trials and has summarized various groups of drugs that can be life-altering in patients diagnosed with NAFLD. This study also discusses the obstacles in taking these clinical trials to bedside treatment.

The Experiences and the Needs of Caregivers of Patients With Head and Neck Cancer: An Integrative Review.

BACKGROUND: Head and neck cancer (HNC) is a devastating disease, and its corresponding treatments can result in substantial functional challenges for patients. These patients require a considerable amount of care, and the tasks of caregiving can be challenging for the caregivers. To date, there is no published literature review on the experiences and the needs of caregivers of patients with HNC. OBJECTIVE: To synthesize the literature on the experiences and needs of caregivers of patients with HNC in order to inform the development of an educational intervention for the caregivers. METHODS: An integrative literature review was conducted to examine the current knowledge about the experiences and needs of caregivers of patients with HNC. A systematic literature search strategy was conducted in CINAHL, MEDLINE, PsycINFO, and Scopus. The dominant or recurrent themes were identified using thematic synthesis. RESULTS: Twenty studies met the inclusion criteria. Three central themes were identified. These were the following: disruption to daily life, the impact of caregiving, and the availability of information and support. CONCLUSIONS: Head and neck cancer affects the caregivers' lives physically, psychosocially, and financially. Caregivers identified the need for informational, financial, and educational support on an ongoing basis in assisting their loved ones with HNC. IMPLICATIONS FOR PRACTICE: Ongoing assessment of caregivers' support needs may contribute to enhancing the care and management of patients with HNC and is essential to promptly identify the concerns of caregivers. Clinicians should view the caregivers as copartners in HNC management and offer adequate support and education programs relevant to their needs.

Predictors of COVID-19 severity: A literature review.

The coronavirus disease 2019 (COVID-19) pandemic is a rapidly evolving global emergency that continues to strain healthcare systems. Emerging research describes a plethora of patient factors-including demographic, clinical, immunologic, hematological, biochemical, and radiographic findings-that may be of utility to clinicians to predict COVID-19 severity and mortality. We present a synthesis of the current literature pertaining to factors predictive of COVID-19 clinical course and outcomes. Findings associated with increased disease severity and/or mortality include age > 55 years, multiple pre-existing comorbidities, hypoxia, specific computed tomography findings indicative of extensive lung involvement, diverse laboratory test abnormalities, and biomarkers of end-organ dysfunction. Hypothesis-driven research is critical to identify the key evidence-based prognostic factors that will inform the design of intervention studies to improve the outcomes of patients with COVID-19 and to appropriately allocate scarce resources.

Evaluating HIV Viral Rebound Among Persons on Suppressive Antiretroviral Treatment in the Era of "Undetectable Equals Untransmittable (U†=†U)".

BACKGROUND: Studies have demonstrated that persons with HIV (PWH) maintaining viral suppression do not transmit HIV to HIV-negative partners through condomless sex, leading to the "Undetectable = Untransmittable (U = U)" prevention campaign. However, few studies have examined the durability of suppression in the era of U = U. METHODS: This retrospective cohort study was conducted in Providence, Rhode Island. PWH aged ≥18 years with documented viral suppression (defined as at least 1 viral load [VL] <200 copies/mL and no VL ≥200 copies/mL) in 2015 were included in the baseline cohort. Primary outcomes were viral suppression, viral rebound (at least 1 VL ≥200 copies/mL), or gap in VL monitoring assessed annually from 2016 to 2019. Those with viral rebound were assessed for resuppression within 6 months. Demographic and clinical characteristics associated with viral rebound or gaps in VL monitoring were investigated by bivariate analysis and logistic regression. RESULTS: A total of 1242 patients with viral suppression were included in the baseline cohort. In each follow-up year, 85%-90% maintained viral suppression, 2%-5% experienced viral rebound, and 8%-10% had a gap in VL monitoring. Among those with viral rebound, approximately one-half were suppressed again within 6 months. In the logistic regression models, retention in care was significantly associated with viral suppression, while younger age, black race, high school or equivalent education, non-men who have sex with men, and history of incarceration were significantly associated with viral rebound. CONCLUSIONS: In the U = U era, most patients with viral suppression who are retained in care are likely to maintain viral suppression over time. Some patients require additional support for regular VL monitoring.

Remdesivir Use Compared With Supportive Care in Hospitalized Patients With Severe COVID-19: A Single-Center Experience.

BACKGROUND: The US Food and Drug Administration issued an Emergency Use Authorization for remdesivir use in patients with severe COVID-19. METHODS: We utilized data from 2 quaternary acute care hospitals. The outcomes of interest were the impact of remdesivir on in-hospital death by day 28 and time to recovery, clinical improvement, and discharge. We utilized Cox proportional hazards models and stratified log-rank tests. RESULTS: Two hundred twenty-four patients were included in the study. The median age was 59 years; 67.0% were male; 17/125 patients (13.6%) who received supportive care and 7/99 patients (7.1%) who received remdesivir died. The unadjusted risk for 28-day in-hospital death was lower for patients who received remdesivir compared with patients who received supportive care (hazard ratio [HR], 0.42; 95% CI, 0.16-1.08). Although this trend remained the same after adjusting for age, sex, race, and oxygen requirements on admission (adjusted HR [aHR], 0.49; 95% CI, 0.19-1.28), as well as chronic comorbidities and use of corticosteroids (aHR, 0.44; 95% CI, 0.16-1.23), it did not reach statistical significance. The use of remdesivir was not associated with an increased risk of acute kidney injury (AKI) or liver test abnormalities. Although not statistically significant, the rate ratios for time to recovery, clinical improvement, and discharge were higher in women and black or African American patients. CONCLUSIONS: Patients on remdesivir had lower, albeit not significant, all-cause in-hospital mortality, and the use of remdesivir did not increase the risk for AKI. Promising signals from this study need to be confirmed by future placebo-controlled randomized clinical trials.

Hydroxychloroquine use in hospitalised patients with COVID-19: An observational matched cohort study.

AIM: To assess the efficacy and safety of hydroxychloroquine with or without azithromycin) in hospitalized adult patients with COVID-19. METHODS: We utilized a hospital based prospective data registry. The primary end point was to assess the impact of hydroxychloroquine with or without azithromycin, on outcome, length of hospitalization, and time to clinical improvement. We utilized treatment effects with inverse-probability-weighting and Cox proportional hazards models. All analyses accounted for age, gender, race, severity on admission, days from symptoms onset and chronic comorbidities. RESULTS: 36 patients received hydroxychloroquine and were age- and sex-matched to 72 patients with COVID-19 who received supportive care. Compared to supportive care, the use of HCQ did not shorten the time to clinical improvement (+0.23 days; 95% CI: -1.8-2.3 days) nor did it shorten the duration of hospital stay (+0.91 days; 95% CI: -1.1-2.9 days). Additionally, HCQ did not decrease the risk of COVID-19 in-hospital death (aHR 1.67; 95% CI: 0.29-9.36). Finally, we observed a slight QTc prolongation from a baseline of 444 ± 26 ms to 464 ± 32 ms (mean±SD) among patients receiving hydroxychloroquine with or without azithromycin. CONCLUSION: This study did not yield benefits from hydroxychloroquine use in patients with COVID-19 and monitoring for adverse events is warranted. Nevertheless, the treatment was safely studied under the guidance of an antimicrobial stewardship program.

SARS-CoV-2 and HIV coinfection: clinical experience from Rhode Island, United States.

INTRODUCTION: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has infected >6 million people worldwide since December 2019. Global reports of HIV/SARS-CoV-2 coinfection are limited. To better understand the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons with HIV and improve their care, we present an outpatient and inpatient clinical experience of HIV/SARS-CoV-2 coinfection from Rhode Island, US. METHODS: We describe outpatient and inpatient preparedness for the COVID-19 pandemic, and present a case series of all known patients with HIV/SARS-CoV-2 coinfection at The Miriam Hospital and Rhode Island Hospital, and The Miriam Hospital Infectious Diseases and Immunology Center, in Providence, Rhode Island, US. RESULTS AND DISCUSSION: The Infectious Diseases and Immunology Center rapidly prepared for outpatient and inpatient care of persons with HIV and SARS-CoV-2. Between 30 March and 20 May 2020, 27 patients with HIV were diagnosed with SARS-CoV-2. Twenty were male, six female and one transgender female; average age was 49 years; 13/27 were Hispanic and 6/27 were African American. All had HIV viral load <200 copies/mL and were on antiretroviral therapy with CD4 count range 87 to 1441 cells/µL. Twenty-six of the 27 had common COVID-19 symptoms for one to twenty-eight days and most had other co-morbidities and/or risk factors. Nine of the 27 were hospitalized for one to thirteen days; of those, three lived in a nursing home, six received remdesivir through a clinical trial or emergency use authorization and tolerated it well; eight recovered and one died. Overall, 17% of known Center people had HIV/SARS-CoV-2 coinfection, whereas the comparable state-wide prevalence was 9%. CONCLUSIONS: We highlight challenges of outpatient and inpatient HIV care in the setting of the COVID-19 pandemic and present the largest detailed case series to date from the United States on HIV/SARS-CoV-2 coinfection, adding to limited global reports. The aggregated clinical findings suggest that the clinical presentation and outcomes of COVID-19 appear consistent with those without HIV. Whether SARS-CoV-2 infection is more frequent among persons with HIV remains to be determined. More data are needed as we develop our understanding of how HIV and antiretroviral therapy are affected by or have an impact on this pandemic.

Self-Sustained Visible-Light-Driven Electrochemical Redox Desalination.

The freshwater scarcity and increasing energy demand are two challenging global issues. Herein, we propose a new route for desalination, self-sustained visible-light-driven electrochemical redox desalination. We propose a novel device architecture involving internal integration of a quasi-solid-state dye-sensitized solar cell and continuous redox-flow desalination units with a bifunctional platinized-graphite-paper electrode. Both the solar cell and redox-flow desalination units are integrated using the bifunctional electrode with one side facing the solar cell operating as a positive electrode and the other side facing the redox-flow desalination unit operating as a negative electrode. The solar cell contains a gel-based tri-iodide/iodide redox couple sandwiched between an N719 dye-modified photoanode and cathode. In contrast, the redox-flow desalination consists of re-circulating ferro/ferricyanide redox couple sandwiched between the anode and cathode with two salt streams located between these electrodes. The performances of bifunctional electrodes in both redox couples were thoroughly investigated by electrochemical characterization. The brackish feed can be continuously desalted to the freshwater level by utilizing visible light illumination. As a device, this architecture combines energy conversion and water desalination. This concept bypasses the need for electrical energy consumption for desalination, which provides a novel structural design using photodesalination to facilitate the development of self-sustained solar desalination technologies.