HIV RNA/DNA Levels at Diagnosis Can Predict Immune Reconstitution: A Longitudinal Analysis.

BACKGROUND: HIV DNA mirrors the number of infected cells and the size of the HIV viral reservoir. The aim of this study was to evaluate the effect of pre-cART HIV DNA levels as a predictive marker of immune reconstitution and on the post-cART CD4 counts trends. METHODS: HIV DNA was isolated from PBMCs and quantified by real-time PCR. Immune reconstitution was assessed up to four years. Piecewise-linear mixed models were used to describe CD4 count changes. RESULTS: 148 people living with HIV (PLWH) were included. The highest rate of immune reconstitution was observed during the first trimester. There was a trend showing that high HIV RNA level resulted in greater increase in CD4 count, especially during the first trimester of cART (difference above vs. below median 15.1 cells/µL/month; 95% CI -1.4-31.5; p = 0.073). Likewise, higher HIV DNA level would predict greater CD4 increases, especially after the first trimester (difference above vs. below median 1.2 cells/µL/month; 95% CI -0.1-2.6; p = 0.071). Higher DNA and RNA levels combined were significantly associated with greater CD4 increase past the first trimester (difference high/high vs. low/low 2.1 cells/µL/month; 95% CI 0.3-4.0; p = 0.024). In multivariable analysis, lower baseline CD4 counts predicted a greater CD4 rise. CONCLUSIONS: In successfully treated PLWH, pre-cART HIV DNA and HIV RNA levels are predictors of immune reconstitution.

Detailed Molecular Surveillance of the HIV-1 Outbreak Among People who Inject Drugs (PWID) in Athens During a Period of Four Years.

BACKGROUND: New diagnoses of HIV-1 infection among people who inject drugs (PWID) increased significantly during 2011 in Athens. OBJECTIVE: Our aim was to investigate the patterns of HIV epidemic spread among PWID and to estimate the transmission dynamics for the major local transmission networks (LTNs). METHODS: We analyzed sequences from 2,274 HIV-infected subjects sampled in Greece during 01/01/2011-31/10/2014. Of specimens in our sample, 874 sequences were isolated from HIV-infected PWID. Phylodynamic analysis was performed using birth-death serial skyline models. RESULTS: Phylogenetic analysis revealed that the majority of sequences from PWID (N=746, 85.4%) fell within four LTNs: CRF14_BG (N=456, 58.3%), CRF35_AD (N=149, 19.1%), subtype B (N=118, 15.1%) and A1 (N=59, 7.5%). In addition to PWID, we also found that sequences from 36 non-PWID belonged to the LTNs corresponding to cross-group transmissions. Based on the estimated plots of the effective reproductive number (Re) over time, subtype A1 and CRF35_AD LTNs showed a sharp increase before and during 2011 (maximum value of Re=3.0 and Re=4.6, respectively). For subtype B and CRF14_BG LTNs, the Re was increasing until the end of 2012 (maximum value of Re=3.2 and Re=3.0, respectively). CONCLUSION: HIV transmissions within subtype A1 and CRF35_AD LTNs increased sharply during the early stage of the outbreak, in contrast to subtype B and CRF14_BG. A significant reduction in the number of infections was estimated on all transmission networks from the beginning of 2013 onwards. Prevention measures that took place in the Athens metropolitan area at the end of 2012 including also the ARISTOTLE program may explain this decrease.

Correlative analysis of lateral vertebral radiographic variables and medical outcomes study short-form health survey: a comparative study in asymptomatic volunteers versus patients with low back pain.

This prospective comparative study was designed to investigate the possible link between SF-36 functional status and lateral roentgenographic variables of the standing lumbar spine in patients with low back pain (LBP) versus asymptomatic volunteers. To the authors' knowledge, no previous studies have correlated SF-36 scores and sagittal roentgenographic variables in patients with LBP versus asymptomatic individuals. A total of 100 male volunteers, used as controls, and an equal number of age-, height-, and weight-comparable patients of the same ethnicity with chronic LBP were compared on the basis of roentgenographic and SF-36 data. The roentgenographic variables that were measured included the following: lumbar lordosis, sacral inclination, L1-S1 vertebral inclination, L4-S1 distal lordosis, disc index, and L1-L5 vertebral index. These variables were correlated with the eight SF-36 scales both in patients and controls. As the patients with LBP get older, they show lower functional scores in Role-Emotional (p < 0.01) and Physical Functioning (p < 0.01). Body height was not found to be a predisposition favoring LBP, but tall patients with LBP showed less Bodily Pain than patients of short stature (p < 0.001). This study showed that patients with LBP had significantly lower scores than their asymptomatic counterparts in the following SF-36 scales: Role-Physical (p < 0.01), Bodily Pain (p < 0.01), Role-Emotional (p = 0.058), and Mental Health (p < 0.001). In the controls General Health, Physical Functioning, Social Functioning, and Role-Emotional, Bodily Pain, Mental Health, and Vitality correlated statistically significantly with individuals' age, height, weight, lumbar lordosis, sacral inclination, inclination of L1, L3, and L5 vertebra, L1-L5 vertebral index, and L1-L2, L2-L3, L3-L4, L4-L5, and L5-S1 disc index. For the patients with LBP this study showed that General health, Physical Functioning, Role-Emotional, Social Functioning, and Bodily Pain were significantly correlated with age, height, L1-L2 inclination, distal lordosis, L2-L5 index, and L4-L5 and L5-S1 disc index. This comparative study showed that the functional status of hard-working patients with chronic LBP is associated with degenerative changes on the lateral radiographs of the lumbosacral spine. Spine surgeons should take into consideration the results of this study in reconstruction of painful degenerative lumbosacral spine.

Natural History of Untreated Scoliosis in beta-Thalassemia.

STUDY DESIGN: A prospective study was performed. OBJECTIVES: To investigate the natural history of untreated scoliosis in beta-thalassemia patients in a 10-year period. SUMMARY OF BACKGROUND DATA: Several previous studies have demonstrated the bone deformities, particularly the high incidence of scoliosis, that is associated with beta-thalassemia. However, little is known about the evolution of scoliosis curvatures, and almost nothing is known about the natural history of this type of scoliosis and its associated lateral spinal curvatures. METHODS: From a group of 115 patients with beta-thalassemia who were evaluated for scoliosis 10 years ago, 43 patients (37%) were re-evaluated 10 years later to study the evolution of the untreated scoliosis and lateral spinal curvatures. Scoliosis, thoracic kyphosis, thoracolumbar kyphosis, and lumbar lordosis were measured both in the initial and last observation and were compared with each other. All changes in scoliosis curve location, direction, and rate of resolving, as well as the changes in the magnitude of the lateral spine curves, were recorded. RESULTS: Scoliosis curves of more than 5 degrees were present in 34 (79%) of the 43 patients who were followed. Scoliosis progressed but was not statistically significant in 12% of the patients with thalassemia in a 10-year span. Ten years ago, 12 patients (28%) showed scoliosis of 10 degrees to 14 degrees, whereas in the last evaluation, 15 patients (35%) had scoliosis of 10 degrees to 19 degrees. The S-shaped scoliosis curve pattern was the most common (29%). In 10 years, the scoliosis curve pattern remained unchanged in 38% of the patients, and it changed in 38%, whereas 24% of the minor curves (5-9 degrees ) showed spontaneous "self-resolving" character. In the last evaluation, there were seven patients (16%) with new cases of scoliosis de novo. There was no sex-related predominance in prevalence of scoliosis in this series. There was a significant skeletal mature retardation in the patients with beta-thalassemia. There was a significant increase of thoracic and thoracolumbar kyphosis and a decrease of lumbar lordosis. The changes in the sagittal profile were not correlated to scoliosis in this group of patients. CONCLUSIONS: Scoliosis in beta-thalassemia appeared with increased prevalence but with small curves of 5 degrees to 19 degrees that did not need active orthopedic treatment. However, a few cases progressed to curves less than 20 degrees, and only one patient (2.9%) showed a severe curve that showed much progression. The behavior of scoliosis in beta-thalassemia differs significantly from that in idiopathic scoliosis. The skeletal disorders that are caused by this hematologic dysfunction seem to be responsible for the spinal deformities and their evolution.