Subgingival Microbiota and Longitudinal Glucose Change: The Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS).

Microbial communities along mucosal surfaces throughout the digestive tract are hypothesized as risk factors for impaired glucose regulation and the development of clinical cardiometabolic disease. We investigated whether baseline measures of subgingival microbiota predicted fasting plasma glucose (FPG) longitudinally. The Oral Infections, Glucose Intolerance and Insulin Resistance Study (ORIGINS) enrolled 230 diabetes-free adults (77% female) aged 20 to 55 y (mean ± SD, 34 ± 10 y) from whom baseline subgingival plaque and longitudinal FPG were measured. DNA was extracted from subgingival plaque, and V3 to V4 regions of the 16S rRNA gene were sequenced. FPG was measured at baseline and again at 2 y; glucose change was defined as follow-up minus baseline. Multivariable linear models regressed 2-y glucose change onto baseline measures of community diversity and abundances of 369 individual taxa. A microbial dysbiosis index (MDI) summarizing top individual taxa associated with glucose change was calculated and used in regression models. Models were adjusted for age, sex, race/ethnicity, education, smoking status, body mass index, and baseline glucose levels. Statistical significance was based on the false discovery rate (FDR; <0.05) or a Bonferroni-corrected P value of 1 × 10-4, derived from the initial 369 hypothesis tests for specific taxa. Mean 2-y FPG change was 1.5 ± 8 mg/dL. Baseline levels of 9 taxa predicted FPG change (all FDR <0.05), among which Stomatobaculum sp oral taxon 097 and Atopobium spp predicted greater FPG change, while Leptotrichia sp oral taxon 498 predicted lesser FPG change (all 3 P values, Bonferroni significant). The MDI explained 6% of variation in longitudinal glucose change (P < 0.001), and baseline glucose levels explained 10% of variation (P < 0.0001). FPG change values ± SE in the third versus first tertile of the MDI were 4.5 ± 0.9 versus 1.6 ± 0.9 (P < 1 × 10-4). Subgingival microbiota predict 2-y glucose change among diabetes-free men and women.

HIV and AIDS in Haiti: recent developments.

PIP: Both the seroprevalence and epidemiology of human immunodeficiency virus (HIV) infection have demonstrated substantial changes in Haiti since the beginning of the epidemic in the early 1980s. Although seroprevalence rates vary greatly according to the population group tested, surveys of healthy urban adults have indicated an increase in HIV infection from about 8% in 1986 to 11% in 1991. The rate in rural areas remains at about 3%. Tuberculosis, herpes zoster, malignant prurigo, and weight loss are the most common signs of HIV infection before the virus progresses to acquired immunodeficiency syndrome (AIDS). The most significant changes in the pattern of HIV transmission in Haiti have been a decline in the proportion of cases among bisexuals/homosexuals (from 50% in 1983 to 1% since 1987) or related to blood transfusion. Also striking has been a change in the geographic distribution of HIV. In 1982, 80% of those infected with HIV were from the capital Port-au-Prince, 10% were from other major cities, and 10% were from other countries. In 1990, only 65% of cases originated from the Port-au-Prince area. Finally, there has been a shift in the sex distribution of HIV, with women contributing 38% of cases in 1989-90 compared to only 15% in 1979-82. Disturbing are survey findings that HIV-infected women, or those with an infected partner, continue to have unprotected sexual intercourse and to take no steps to avoid pregnancy. As a result of the growing number of AIDS cases among women, children under 14 years of age now comprises 6.6% of all AIDS cases compared to 2.4% in 1988. Development of a form of contraception that is as effective against HIV transmission as the condom yet could be used without the consent of the male partner would be an important advance in AIDS prevention in Haiti.^ieng