RESUMEN
Healthcare workers (HCWs) have increased exposure and subsequent risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This case-control study was conducted to investigate the contemporaneous risks associated with confirmed SARS-CoV-2 infection amongst HCWs following in-work exposure to a confirmed coronavirus disease-2019 (COVID-19) case. We assessed the influence of demographic (age, sex, nationality, high risk co-morbidities and vaccination status) and work-related factors (job role, exposure location, contact type, personal protective equipment (PPE) use) on infection risk following nosocomial SARS-CoV-2 exposure. All contact tracing records within the hospital site during waves 1-3 of the COVID-19 pandemic in Ireland were screened to identify exposure events, cases and controls. In total, 285 cases and 1526 controls were enrolled, as a result of 1811 in-work exposure events with 745 index cases. We demonstrate that male sex, Eastern European nationality, exposure location, PPE use and vaccination status all impact the likelihood of SARS-CoV-2 infection following nosocomial SARS-CoV-2 exposure. The findings draw attention to the need for continuing emphasis on PPE use and its persisting benefit in the era of COVID-19 vaccinations. We suggest that non-work-related factors may influence infection risk seen in certain ethnic groups and that infection risk in high-risk HCW roles (e.g. nursing) may be the result of repeated exposures rather than risks inherent to a single event.
Asunto(s)
COVID-19 , Infección Hospitalaria , Masculino , Humanos , Pandemias , COVID-19/epidemiología , SARS-CoV-2 , Estudios de Casos y Controles , Irlanda/epidemiología , Infección Hospitalaria/epidemiología , Personal de Salud , Factores de Riesgo , HospitalesRESUMEN
BACKGROUND: HIV infection is associated with an increased risk of morbidity and mortality from vaccine preventable infections. This research describes, in the context of changing patient demographics, the seroprevalence of vaccine preventable viral infections among attendees of the largest centre for HIV positive patients in Ireland. METHODS: Baseline serum IgG results for measles, mumps, rubella, varicella zoster virus (VZV) & hepatitis A, as well as hepatitis B sAg, cAb and sAb results, were retrieved for 2534 clinic attendees attending in 2018. Results were available for between 990 and 2363 attendees (39-93%), depending on the test, and were compared with 2013 clinic data. RESULTS: There was a 35% increase in attendees in 2018 when compared to 2013. The largest increase was in attendees of South American origin. In 2018, males accounted for 73% of the entire cohort and the HIV acquisition risk for 48% of attendees was MSM. 47% of attendees were originally from Ireland. Among those tested, 33% were susceptible to at least one component of the MMR vaccine. 5% were VZV non-immune (significantly associated with younger age and the acquisition risk status of injection drug use). 21% were hepatitis A non-immune (significantly associated with younger age and being of European or South American origin). 32% were hepatitis B cAb seropositive (significantly associated with older age, injection drug use status and being originally from Africa). 3% demonstrated hepatitis B sAg positivity. 64% had hepatitis B sAb ≥ 10mIU. CONCLUSION: In a cohort of attendees to an HIV clinic in a large urban setting, the susceptibility to several common vaccine preventable viral infections, in particular MMR and hepatitis A and B, was high. These results highlight the importance of proactive screening and immunisation to help protect this high risk patient group against vaccine preventable diseases.
Asunto(s)
Infecciones por VIH , Hepatitis A , Hepatitis B , Sarampión , Paperas , Rubéola (Sarampión Alemán) , Minorías Sexuales y de Género , Enfermedades Prevenibles por Vacunación , Virosis , Anticuerpos Antivirales , Demografía , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Hepatitis A/epidemiología , Hepatitis A/prevención & control , Hepatitis B/complicaciones , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Herpesvirus Humano 3 , Homosexualidad Masculina , Humanos , Irlanda/epidemiología , Masculino , Sarampión/prevención & control , Vacuna contra el Sarampión-Parotiditis-Rubéola , Paperas/prevención & control , Rubéola (Sarampión Alemán)/prevención & control , Estudios SeroepidemiológicosRESUMEN
Aims Since its emergence, significant interest surrounds the use of SARS-CoV-2 serological tests as an alternative or as an adjunct to molecular testing. However, given the speed of this pandemic, paralleled with the pressure to develop and provide serological tests in an expediated manner, not every assay has undergone the rigorous evaluation that is usually associated with medical diagnostic assays. We aimed to examine the performance of several commercially available SARS-CoV-2 IgG antibody assays among participants with confirmed COVID-19 disease and negative controls. Methods Serum taken between day 17 and day 40 post onset of symptoms from 41 healthcare workers with RT-PCR confirmed COVID-19 disease, and pre-pandemic serum from 20 negative controls, were tested for the presence of SARS-CoV-2 IgG using 7 different assays including point-of-care (POC) and laboratory-based assays. Results Assay performance varied. The lab-based Abbott diagnostics SARS-CoV-2 IgG assay proved to be the assay with the best positive and negative predictive value, and overall accuracy. The POC Nal von Minden GmbH and Biozek assays also performed well. Conclusion Our research demonstrates the variations in performance of several commercially available SARS-CoV-2 antibody assays. These findings identify the limitations of some serological tests for SARS-CoV-2. This information will help inform test selection and may have particular relevance to providers operating beyond accredited laboratories.
Asunto(s)
Prueba de COVID-19/estadística & datos numéricos , COVID-19/diagnóstico , Personal de Salud/estadística & datos numéricos , SARS-CoV-2/aislamiento & purificación , Anticuerpos Antivirales/sangre , Humanos , Inmunoglobulina G/sangre , Sistemas de Atención de Punto/estadística & datos numéricos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/normasRESUMEN
BACKGROUND: The goal of this study was to evaluate the perifoveal capillary bed and to analyze areas of non-flow using optical coherence tomography angiography (OCT-A) in patients presenting with diabetic retinopathy (DR), correlating them to the severity of DR, type of diabetes and visual acuity (VA). PATIENTS AND METHODS: The non-flow area (NFA) and foveal avascular zone (FAZ) in the superficial (SCP) and deep capillary plexus (DCP) were calculated using OCT-A imaging of patients with DR followed between July 2015 and March 2016 at the Jules Gonin Eye Hospital (Lausanne, Switzerland). Disease severity was classified using the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Analysis of variance was used to correct for correlation between eyes. RESULTS: Seventy-eight eyes of 53 patients were included (29 men; 44 right eyes). There were 45 eyes with non-proliferative DR (NPDR; stage 1 [n=14], stage 2 [n=7], and stage 3 [n=24]) and 33 with proliferative DR (PDR; stage 1 [n=17], stage 2 [n=16]) included, among which 26 had type I diabetes and 52 type II diabetes. The mean Best Corrected Visual Acuity (BCVA) was 78.5 letters. The mean NFA in the SCP differed according to diabetes type and stage of DR (type 1 diabetes: NPDR, 0.76±0.3, PDR, 1.24±0.7; type 2 diabetes: NPDR, 1.46±0.7, PDR, 1.57±0.7). CONCLUSION: The NFA, measured by OCTA, may be a useful indicator of DR severity, especially in the superficial capillary plexus. Loss of visual acuity might be correlated with increasing NFA (excluding the FAZ or not), primarily among patients with type II diabetes and NPDR.
Asunto(s)
Diabetes Mellitus Tipo 2 , Retinopatía Diabética , Mácula Lútea , Capilares , Estudios Transversales , Diabetes Mellitus Tipo 2/complicaciones , Retinopatía Diabética/complicaciones , Retinopatía Diabética/diagnóstico , Angiografía con Fluoresceína , Humanos , Masculino , Vasos Retinianos/diagnóstico por imagen , Tomografía de Coherencia Óptica , Agudeza VisualRESUMEN
INTRODUCTION: Anal squamous cell carcinoma (ASCC) is a rare malignancy with rising incidence rates. Risk factors include human immunodeficiency virus (HIV) infection, high-risk sexual activity and HPV-related genitourinary dysplasia/neoplasia. There is an overlap between high-risk patients and those attending HIV Medicine/Sexual Health (HMSH) services. We hypothesised that HMSH involvement may facilitate earlier referral to colorectal surgeons, with better outcomes. METHODS: Retrospective review of all ASCC and anal intraepithelial neoplasia (AIN) treated at a tertiary-referral hospital with a dedicated HMSH clinic between 2000 and 2018. Comparative analysis was performed of demographics, management and outcomes between HMSH and non-HMSH patients. RESULTS: One hundred and nine patients had anal pathology, eighty-five with ASCC (78%) and twenty-four with AIN (22%). Seventy (64%) were male. Median (range) age at ASCC diagnosis was 51 years (26-88). Thirty-six percent of all patients attended HMSH services, 28% were HIV positive, and 41% of males were men-who-have-sex-with-men (MSM). Eighty-one ASCC patients (97.5%) were treated with curative intent. Sixty-seven (80%) had primary chemoradiation therapy. Fifteen (17.5%) had primary surgical excision. Twelve (14%) developed recurrent disease. Ultimately, seven required salvage APR. Overall 3-year survival (3YS) was 76%. HMSH patients were significantly younger at ASCC diagnosis (p < 0.001), with a higher prevalence of HIV, HPV and MSM. HMSH attenders also tended to be diagnosed at earlier stages, were less likely to develop recurrence and achieved better overall outcomes, with a superior overall 3YS than non-HMSH patients (92% vs 72%, p = 0.037). CONCLUSION: ASCC incidence is increasing worldwide. The HMSH cohort has emerged as a distinct subpopulation of younger, high-risk, male patients. Collaboration between HMSH and colorectal surgeons offers an opportunity for risk reduction strategies and earlier intervention.
Asunto(s)
Neoplasias del Ano , Carcinoma in Situ , Carcinoma de Células Escamosas , Enfermedades Transmisibles , Infecciones por VIH , Infecciones por Papillomavirus , Minorías Sexuales y de Género , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/epidemiología , Neoplasias del Ano/terapia , Carcinoma in Situ/epidemiología , Carcinoma in Situ/terapia , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/terapia , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/terapia , Estudios Retrospectivos , Centros de Atención Terciaria , Adulto JovenAsunto(s)
COVID-19/epidemiología , Hospitalización/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , SARS-CoV-2 , Anciano , Índice de Masa Corporal , COVID-19/diagnóstico , COVID-19/terapia , Comorbilidad , Estudios Transversales , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Respiración Artificial/estadística & datos numéricos , Reacción en Cadena de la Polimerasa de Transcriptasa InversaAsunto(s)
Neoplasias del Ano/diagnóstico , Detección Precoz del Cáncer/psicología , Seropositividad para VIH , Prueba de Papanicolaou/psicología , Aceptación de la Atención de Salud/psicología , Adulto , Tacto Rectal/psicología , Desconcierto , Seropositividad para VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Prueba de Papanicolaou/efectos adversos , Minorías Sexuales y de Género/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Invasive pneumococcal diseases (IPDs) remain a significant cause of morbidity and mortality in human immunodeficiency virus (HIV)-positive individuals despite the widespread use of highly active antiretroviral therapy (HAART) and availability of pneumococcal vaccines. The aim of this study was to measure temporal trends in incidence and risk factors for IPD (defined as culture of Streptococcus pneumoniae from blood, cerebrospinal fluid or both) in a cohort of HIV-positive patients attending an ambulatory HIV care centre in Dublin, Ireland over a 10-year period 2006-2015. Incidence of IPD was determined as events per 100,000 person-years' follow-up. Poisson regression was used to assess linear trend in incidence over time. A nested case-control study (four controls per case) was undertaken to assess risk factors for IPD. Forty-seven episodes of IPD were identified in 42 HIV-positive individuals (median [IQR] age 38 years [33-43], 69% male, 86% injecting drug users (IDUs), median CD4 T-cell count 213 cells/mm3) over 16,008 person-years' follow-up (overall incidence rate 293/100,000 person-years). Three patients had two episodes and one patient had three episodes of IPD during the study period. The overall case fatality rate was 15% (95% confidence interval [CI] 4-24%). The incidence of IPD per 100,000 person-years decreased from 728 (95% CI, 455-1002), to 242 (95% CI, 120-365) to 82 (95% CI, 40-154) in calendar periods 2006-2008, 2009-2012 and 2013-2015, respectively (p < 0.01 for linear trend). Older age (p = 0.02), male gender (p = 0.05), detectable HIV viral load (p < 0.01) and non-receipt of pneumococcal vaccine (p = 0.03) were associated with IPD while IDU as risk of acquisition of HIV was of borderline significance (p = 0.06). HIV-positive individuals remain at greater risk of IPD compared to the general population. Pneumococcal vaccine should be seen as a priority to ensure optimal protection for HIV-positive patients.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Seropositividad para VIH/complicaciones , Infecciones Neumocócicas/epidemiología , Streptococcus pneumoniae/aislamiento & purificación , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Terapia Antirretroviral Altamente Activa/métodos , Estudios de Casos y Controles , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Incidencia , Irlanda/epidemiología , Masculino , Infecciones Neumocócicas/complicaciones , Infecciones Neumocócicas/diagnóstico , Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/inmunología , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/epidemiologíaRESUMEN
Gutless phallodrilines are marine annelid worms without a mouth or gut, which live in an obligate association with multiple bacterial endosymbionts that supply them with nutrition. In this study, we discovered an unusual symbiont community in the gutless phallodriline Inanidrilus exumae that differs markedly from the microbiomes of all 22 of the other host species examined. Comparative 16S rRNA gene sequence analysis and fluorescence in situ hybridization revealed that I. exumae harbors cooccurring gamma-, alpha-, and deltaproteobacterial symbionts, while all other known host species harbor gamma- and either alpha- or deltaproteobacterial symbionts. Surprisingly, the primary chemoautotrophic sulfur oxidizer "Candidatus Thiosymbion" that occurs in all other gutless phallodriline hosts does not appear to be present in I. exumae Instead, I. exumae harbors a bacterial endosymbiont that resembles "Ca Thiosymbion" morphologically and metabolically but originates from a novel lineage within the class Gammaproteobacteria This endosymbiont, named Gamma 4 symbiont here, had a 16S rRNA gene sequence that differed by at least 7% from those of other free-living and symbiotic bacteria and by 10% from that of "Ca Thiosymbion." Sulfur globules in the Gamma 4 symbiont cells, as well as the presence of genes characteristic for autotrophy (cbbL) and sulfur oxidation (aprA), indicate that this symbiont is a chemoautotrophic sulfur oxidizer. Our results suggest that a novel lineage of free-living bacteria was able to establish a stable and specific association with I. exumae and appears to have displaced the "Ca Thiosymbion" symbionts originally associated with these hosts.IMPORTANCE All 22 gutless marine phallodriline species examined to date live in a highly specific association with endosymbiotic, chemoautotrophic sulfur oxidizers called "Ca Thiosymbion." These symbionts evolved from a single common ancestor and represent the ancestral trait for this host group. They are transmitted vertically and assumed to be in transition to becoming obligate endosymbionts. It is therefore surprising that despite this ancient, evolutionary relationship between phallodriline hosts and "Ca Thiosymbion," these symbionts are apparently no longer present in Inanidrilus exumae They appear to have been displaced by a novel lineage of sulfur-oxidizing bacteria only very distantly related to "Ca Thiosymbion." Thus, this study highlights the remarkable plasticity of both animals and bacteria in establishing beneficial associations: the phallodriline hosts were able to acquire and maintain symbionts from two very different lineages of bacteria, while sulfur-oxidizing bacteria from two very distantly related lineages were able to independently establish symbiotic relationships with phallodriline hosts.
Asunto(s)
Chromatiaceae/fisiología , Oligoquetos/microbiología , Simbiosis , Animales , Chromatiaceae/clasificación , Chromatiaceae/genética , Genes Bacterianos , Hibridación Fluorescente in Situ , Filogenia , ARN Bacteriano/análisis , ARN Ribosómico 16S/análisis , Análisis de Secuencia de ARNRESUMEN
BACKGROUND: Doctors' continuing professional development (CPD) training needs are known to be strongly influenced by national and local contextual characteristics. Given the changing national demographic profile and government-mandated changes to primary care health care provision, this study aimed to investigate Irish General Practitioners' (GPs) perceptions of, and preferences for, current and future CPD programmes. METHODS: A cross-sectional questionnaire, using closed- and open-ended questions, was administered to Irish GPs, focusing on training needs analysis; CPD course content; preferred format and the learning environment. RESULTS: The response rate was 719/1000 (71.9%). GPs identified doctor-patient communication as the most important and best-performed GP skill. Discrepancies between perceived importance (high) and current performance (low) emerged for time/workload management, practice finance and business skills. GPs identified clinically-relevant primary care topics and non-clinical topics (stress management, business skills, practice management) as preferences for future CPD. Flexible methods for CPD delivery were important. Gender and practice location (urban or rural) significantly influenced CPD participation and future course preference. CONCLUSION: The increasing diversity of services offered in the Irish primary care setting, in both clinical and non-clinical areas, should be tailored based to include GP practice location and structure.
Asunto(s)
Educación Médica Continua/métodos , Médicos Generales/educación , Competencia Clínica , Estudios Transversales , Femenino , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Prior to the introduction of viral inactivation of factor concentrates and screening of blood, 225 people with haemophilia became infected with hepatitis C (HCV) in Ireland. AIM: Our aim was to assess liver disease progression and mortality in this population after 30 years of infection. METHODS: Demographic and clinical data were collected from medical records in five hepatology units and one infectious disease unit retrospectively in 2005, and on four subsequent occasions. RESULTS: The participation rate was 73% (165/225). Eighty three percent of patients, who had been tested for RNA (n = 106/128), developed chronic HCV infection. Thirty four percent were co-infected with HIV. All-cause mortality, after approximately 30 years of infection with chronic HCV, was 44% in HIV positive patients and 29% in HIV negative patients. Liver-related mortality was 12.5% and did not vary significantly by HIV status. Thirty seven percent of patients had developed advanced liver disease, including 20% with cirrhosis and 9% with hepatocellular carcinoma. In the pre-interferon-free direct acting antivirals era, 57% (n = 60/106) of patients were treated for HCV, 65% of whom achieved a sustained virological response. Successfully treated patients had few adverse liver outcomes. CONCLUSION: After 30 years of infection, 40% of the patients who had evidence of chronic HCV had developed advanced liver disease, such as cirrhosis and HCC, or had died from liver-related causes. This proportion is high relative to similar international cohorts despite good anti-HCV treatment uptake and responses.
Asunto(s)
Hemofilia A/complicaciones , Hemofilia A/epidemiología , Hemofilia B/complicaciones , Hemofilia B/epidemiología , Hepatitis C/complicaciones , Hepatitis C/epidemiología , Antivirales/uso terapéutico , Coinfección , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Genotipo , Infecciones por VIH , Hepacivirus , Hepatitis C/tratamiento farmacológico , Hepatitis C/virología , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/virología , Humanos , Irlanda/epidemiología , Estimación de Kaplan-Meier , Cirrosis Hepática/epidemiología , Cirrosis Hepática/etiología , Cirrosis Hepática/mortalidad , Masculino , Vigilancia de la Población , Modelos de Riesgos Proporcionales , Resultado del Tratamiento , Carga ViralRESUMEN
BACKGROUND: We investigated the real-world effectiveness of interferon-free regimens for the treatment of patients with compensated cirrhosis infected with hepatitis C virus (HCV). METHOD: Using the Irish national HCV treatment registry, the effectiveness and safety of interferon-free regimens for HCV-infected patients treated between April 2015 and August 2016, was determined. RESULTS: A SVR12 was achieved in 86% of subjects treated with sofosbuvir/ledipasvir ± ribavirin (SOF/LDV±RBV), 93% treated with paritaprevir, ombitasvir and ritonavir combined with dasabuvir ± ribavirin (3D±RBV) and 89% treated with sofosbuvir/daclatasvir ± ribavirin (SOF/DCV±RBV). The discontinuation rate was 5% and the on-treatment mortality rate was 1%. CONCLUSION: The availability of interferon-free regimens represents a significant breakthrough for the treatment of HCV infection. Treatments options, with high SVR12 rates, are now available for patients with compensated cirrhosis who were unsuitable for treatment with interferon-based regimens. Data obtained from studies conducted in real world practice provide robust information fundamental for input into future economic evaluations for agents used for the treatment of HCV infection.
Asunto(s)
Antivirales/uso terapéutico , Bencimidazoles/uso terapéutico , Fluorenos/uso terapéutico , Accesibilidad a los Servicios de Salud , Hepacivirus/efectos de los fármacos , Hepatitis C/tratamiento farmacológico , Cirrosis Hepática/tratamiento farmacológico , Ribavirina/uso terapéutico , Uridina Monofosfato/análogos & derivados , Adulto , Antivirales/efectos adversos , Bencimidazoles/efectos adversos , Quimioterapia Combinada , Femenino , Fluorenos/efectos adversos , Genotipo , Hepacivirus/genética , Hepacivirus/crecimiento & desarrollo , Hepatitis C/complicaciones , Hepatitis C/diagnóstico , Hepatitis C/mortalidad , Humanos , Irlanda , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/mortalidad , Cirrosis Hepática/virología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Sistema de Registros , Ribavirina/efectos adversos , Sofosbuvir , Respuesta Virológica Sostenida , Factores de Tiempo , Resultado del Tratamiento , Uridina Monofosfato/efectos adversos , Uridina Monofosfato/uso terapéuticoRESUMEN
Malaria is the most serious parasitic infection. At our institution over a two year period there were treatment errors in 18% (n=3) of cases. The aim of this multidisciplinary study was to ensure appropriate and timely treatment of malaria by implementation of a cluster of interventions: reconfiguration of existing guidelines, provision of prescribing information; delivery of education sessions to front-line staff and enabling rapid access to medication. Staff feedback was assessed through a questionnaire. Perceived benefits gained included awareness of guidelines (91%, n= 39), how to diagnose (81%, n =35), how to treat (86%, n=37), that treatment must be prompt (77%, n=33) and where to find treatment out of hours (84%, n=36). 'Others' perceived benefits (5% n= 2) noted referred to treatment in pregnancy. Going forward, a programme of on-going staff education, repeated audits of guideline compliance and promotion of reporting of medication errors should help ensure that these benefits are sustained.
Asunto(s)
Malaria/tratamiento farmacológico , Errores de Medicación , Femenino , Adhesión a Directriz , Hospitales de Enseñanza , Humanos , Irlanda , Personal de Hospital/educación , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológicoRESUMEN
The aim of this study was to compare the immunologic response to a prime-boost immunization strategy combining the 13-valent conjugate pneumococcal vaccine (PCV13) with the 23-valent polysaccharide pneumococcal vaccine (PPSV23) versus the PPSV23 alone in HIV-infected adults. HIV-infected adults were randomized to receive PCV13 at week 0 followed by PPSV23 at week 4 (n = 31, prime-boost group) or PPSV23 alone at week 4 (n = 33, PPSV23-alone group). Serotype specific IgG geometric mean concentration (GMC) and functional oposonophagocytic (OPA) geometric mean titer (GMT) were compared for 12 pneumococcal serotypes shared by both vaccines at week 8 and week 28. The prime-boost vaccine group were more likely to achieve a ≥2-fold increase in IgG GMC and a GMC >1 ug/ml at week 8 (odds ratio (OR) 2.00, 95% confidence interval (CI) 1.46-2.74, p < 0.01) and week 28 (OR 1.95, 95% CI 1.40-2.70, p < 0.01). Similarly, the prime-boost vaccine group were more likely to achieve a ≥4-fold increase in GMT at week 8 (OR 1.71, 95% CI 1.22-2.39, p < 0.01) and week 28 (OR 1.6, 95% CI 1.15-2.3, p < 0.01). This study adds to evidence supporting current pneumococcal vaccination recommendations combining the conjugate and polysaccharide pneumococcal vaccines in the United States and Europe for HIV-infected individuals.
Asunto(s)
Infecciones por VIH/inmunología , Vacunas Neumococicas/inmunología , Vacunas Neumococicas/uso terapéutico , Neumonía Neumocócica/prevención & control , Adulto , Anticuerpos Antibacterianos/sangre , Femenino , Humanos , Masculino , Neumonía Neumocócica/inmunologíaRESUMEN
Background Men who have sex with men (MSM), particularly HIV-infected MSM are disproportionately affected by HPV infection and associated disease. The HPV vaccine has potential to greatly reduce the burden of HPV-associated disease including anal cancer in MSM. The efficacy of the HPV vaccine is dependent on high levels of vaccine uptake. The aim of this study was to examine HPV vaccine acceptability and factors influencing vaccine acceptability in MSM in Ireland. Methods A self-administered survey was distributed to HIV-infected and HIV negative MSM examining HPV vaccine acceptability and factors associated with vaccine acceptability. Logistic regression was used to identify key variables and predictors of HPV vaccine acceptability. Results 302 MSM participated in the study. Acceptability of HPV vaccine was 31% (unconditional), 51% (conditional on stated efficacy and a cost of 300), 65% (conditional on stated efficacy and a cost of 100) and 78% (conditional on stated efficacy and no cost). Cost was negatively associated with HPV vaccine acceptability (p<0.01) while knowledge of HPV vaccine efficacy was significantly associated with vaccine acceptability, even in the context of associated cost (p<0.01). Conclusions Acceptability of HPV vaccine in MSM in Ireland is high based on no cost vaccine and on stated vaccine efficacy (78%). Cost is negatively associated with vaccine acceptability. Understanding levels of knowledge of HPV infection, HPV associated disease and attitudes toward HPV vaccination are important as they will contribute to HPV vaccine acceptability among MSM and will help guide effective preventive programs.
Asunto(s)
Infecciones por VIH/complicaciones , Homosexualidad Masculina , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Aceptación de la Atención de Salud , Vacunación/psicología , Adolescente , Adulto , Humanos , Irlanda , Masculino , Vacunas contra Papillomavirus/economía , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: To report the use of intrastromal voriconazole injections combined with corneal debridement to treat deep recalcitrant fungal keratitis. HISTORY AND SIGNS: Three patients (2 female and 1 male) with culture proven fungal keratitis (1 Fusarium, 1 Candida, 1 Pseudallescheria boydii) were included in this study. The patients were treated with repeated intrastromal voriconazole (100 mg/1 ml) in combination with corneal debridement. THERAPY AND OUTCOME: The mean age of the patients was 65 years. The mean number of injections was 5. The patients were injected every 2-3 days. This technique required repeated corneal debridement to achieve complete resolution in these three cases. CONCLUSIONS: Repeated intrastromal injection of voriconazole in combination with corneal debridement appears to be an effective and safe way to treat recalcitrant fungal keratitis, even in Fusarium keratitis.
Asunto(s)
Antifúngicos/administración & dosificación , Córnea/cirugía , Desbridamiento/métodos , Infecciones Fúngicas del Ojo/terapia , Queratitis/terapia , Voriconazol/administración & dosificación , Anciano , Terapia Combinada , Esquema de Medicación , Infecciones Fúngicas del Ojo/diagnóstico , Femenino , Humanos , Inyecciones Intraoculares , Queratitis/diagnóstico , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: HIV-positive substance dependent patients contribute disproportionally to HIV morbidity and mortality as a result of poor compliance with their HIV treatment. For HIV-positive opiate-dependent patients integrating HIV and addiction care improves HIV morbidity but the effect on addiction morbidity is not known. AIMS: This study aims to establish if integrating HIV and addiction care has a significant effect on addiction and HIV morbidity for non-engaging HIV-positive opiate-dependent patients. METHODS: Patients attending the National Drug Treatment Centre who had disengaged from their HIV treatment in St James's Hospital were recruited to receive HIV care integrated into their methadone maintenance programme. Outcome was investigated in terms of urine toxicology (opiates, cocaine, cannabis and amphetamines); adherence to methadone; proportion receiving directly observed antiretroviral therapy; proportion HIV virally suppressed; and the CD4 cell count. RESULTS: No significant change in substance use or methadone adherence was demonstrated in the 19 recruited participants. There was a significant increase in the proportion receiving directly observed antiretroviral therapy, and in the CD4 cell count. CONCLUSION: Integration of HIV and addiction care optimises the physical health of non-engaging HIV-positive opiate-dependent patients with no substantial effect on their methadone maintenance programme.