The EuroSIDA study: 25 years of scientific achievements.

The EuroSIDA study was initiated in 1994 and follows adult people living with HIV (PLHIV) in 100 collaborating clinics across 35 countries covering all European regions, Israel and Argentina. The study aims to study the long-term virological, immunological and clinical outcomes of PLHIV and to monitor temporal changes and regional differences in outcomes across Europe. Annually collected data include basic demographic characteristics, information on AIDS- and non-AIDS-related clinical events, and details about antiretroviral therapy (ART), hepatitis C treatment and other medications, in addition to a range of laboratory values. The summer 2016 data set held data from a total of 23 071 individuals contributing 174 481 person-years of follow-up, while EuroSIDA's unique plasma repository held over 160 000 samples. Over the past 25 years, close to 300 articles have been published in peer-reviewed journals (h-index 52), covering a range of scientific focus areas, including monitoring of clinical and virological outcomes, ART uptake, efficacy and adverse events, the influence of hepatitis virus coinfection, variation in the quality of HIV care and management across settings and regions, and biomarker research. Recognizing that there remain unresolved issues in the clinical care and management of PLHIV in Europe, EuroSIDA was one of the cohorts to found The International Cohort Consortium of Infectious Disease (RESPOND) cohort consortium on infectious diseases in 2017. In celebration of the EuroSIDA study's 25th anniversary, this article aims to summarize key scientific findings and outline current and future scientific focus areas.

Identifying novel Mycobacterium species in fish using multiple gene phylogenetic analysis

Mycobacteria have, for a long time, been suspected to be causing severe disease in ornamental and farmed fish in Trinidad and Tobago (T&T), however, up to now, these mycobacteria species have not been identified and characterised. Many piscine mycobacteria species are also known to be zoonotic, potentially affecting human health. Objective: To identify and characterize the species of mycobacteria affecting fish (and possibly man) in T&T. Design and Methodology: Homogenised internal organs were collected from a total of 13 fish showing clinical signs consistent with mycobacterial infection. Samples were analysed using Ziehl-Neelsen (acid-fast) staining and real-time Polymerase Chain Reaction (rPCR). The species of mycobacteria were further characterised using conventional PCR targeting the 16s rRNA (564 bp), rpoB (396 bp) and sod (408 bp) genes. PCR products were sequenced and the sequences were compared with those from known and recently identified mycobacteria species through phylogenetic analysis. Results: Acid-fast non-branching bacilli were detected in all samples. All samples were also positive for Mycobacterium sp. by real-time PCR. Multi-gene phylogenetic analysis revealed the presence of two distinct species of mycobacteria. One aligned closely with Mycobacterium marinum, a well known pathogen affecting fish and man, and a second aligned closely with a species also known to affect both fish and humans, Mycobacterium stomatepiae. Conclusions: Phylogenetic analysis demonstrated the presence of two mycobacterium species in organs from fish showing clinical signs of Piscine Mycobacteriosis in T&T. Further work is needed to characterise these mycobacteria species and investigate their zoonotic potential.

Edwardsiella ictaluri infection in Pangasius catfish imported from West Bengal into the Southern Caribbean.

In response to a mortality event, seven Pangasius catfish (Pangasianodon hypophthalmus) were submitted to the University of the West Indies, School of Veterinary Medicine, Trinidad and Tobago, for diagnostic evaluation. These fish were part of a consignment that arrived from Kolkata two weeks earlier. Fish presented with perianal haemorrhage and blister-like swellings on the skin which ruptured to leave ulcers. Edwardsiella ictaluri was consistently recovered from the brain and skin. Repetitive sequence-mediated PCR analysis revealed genetic fingerprints consistent with E. ictaluri isolates from farm-raised channel catfish in Mississippi, USA. Plasmid analysis of the case isolates identified two unique plasmids that differ slightly in conformation and content from the pEI1 and pEI2 plasmids described for E. ictaluri from other fish hosts. The case isolates were also PCR negative for several E. ictaluri virulence factors. The biological implications of these genetic differences are unclear and warrant further study. This is the first report and documentation of E. ictaluri infection in Trinidad and Tobago, suggesting the pathogen may have been introduced concurrently with the importation of fish. This report emphasizes the importance of adequate health screenings of imported lots to minimize the threat of introducing E. ictaluri to non-endemic areas.

Transmission risk behaviour at enrolment in participants in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial

OBJECTIVES: A proportion of HIV-positive people have condomless sex. Antiretroviral treatment (ART) reduces infectiousness, but a substantial proportion of HIV-diagnosed people are not yet on ART. We describe baseline self-reported risk behaviours in ART-naïve Strategic Timing of AntiRetroviral Treatment (START) trial participants. METHODS: All START participants completed a risk behaviour questionnaire. Data were collected on sociodemographics, lifestyle factors, health and wellbeing status and clinical status. Recent sexual behaviour and HIV transmission beliefs in the context of ART were also assessed. The primary interest was in condomless sex with serodifferent partners (CLS-D) in the past two months. RESULTS: A total of 4601 of 4685 HIV-positive participants (98%) completed the questionnaire [2559 men who have sex with men (MSM), 803 heterosexual men and 1239 women]. Region of recruitment was Europe/Israel, 33%; South America/Mexico, 25%; Africa, 22%; other, 21%. Median age was 36 years [interquartile range (IQR) 29, 44 years]. Forty-five per cent reported white ethnicity and 31% black ethnicity. Two per cent had HIV viral load < 50 HIV-1 RNA copies/mL. Seventeen per cent (767 of 4601) reported CLS-D; 20% of MSM compared with 10% of heterosexual men and 14% of women. MSM were also more likely to report multiple CLS-D partners. Possible risk limitation measures (reported by more than half of those who had CLS-D) were seropositioning (receptive anal CLS-D only) or withdrawal (insertive anal CLS-D always without ejaculation). CLS-D was more commonly reported by participants from South America/Mexico and North America compared with Europe; among heterosexual men and women CLS-D was also more commonly reported among participants from Africa compared with Europe. Knowledge of ART impact on transmission risk was low. CONCLUSIONS : A substantial minority recruited to the START study reported CLS-D at baseline. CLS-D reporting was higher in MSM than eterosexuals and varied significantly according to region of recruitment. A substantial proportion of MSM reporting CLS-D appear to take transmission risk limitation measures

Seroprevalence of Porcine Circovirus type 2 in swine herds in Trinidad and Tobago.

The seroprevalence of porcine circovirus type 2 (PCV2) in the swine population of Trinidad and Tobago was studied, focusing on the association between the seroprevalence of the virus and each of four variables: gender, age, group, farm size, and geographic location. Farms were classified as large (>1000 sows) or small (2 pigs to 250 sows); three age groups-nursery pigs (3 to 10 weeks, n=82), grower (11 to 22 weeks, n=107), and breeding animals(n=85) were studied. A multistage sampling design with non-proportional sampling between strata (farm sizes) was employed. A total of 274 serum samples were tested, collected from three large farms (n=109) and 109 randomly chosen small farms (n=165). Samples were tested using the PCV type 2 indirect fluorescent antibody test kit by VMRD (USA). Sixty-one percent of the farms tested were positive (2 large farms, 66 small farms). The overall seroprevalence of PCV2 was 62.0% (170/274) and after adjusting for non-proportional sampling between strata, was 70.3% ...

Seroprevalence of Porcine Circovirus type 2 in swine herds in Trinidad and Tobago.

The seroprevalence of porcine circovirus type 2 (PCV2) in the swine population of Trinidad and Tobago was studied, focusing on the association between the seroprevalence of the virus and each of four variables: gender, age, group, farm size, and geographic location. Farms were classified as large (>1000 sows) or small (2 pigs to 250 sows); three age groups-nursery pigs (3 to 10 weeks, n=82), grower (11 to 22 weeks, n=107), and breeding animals(n=85) were studied. A multistage sampling design with non-proportional sampling between strata (farm sizes) was employed. A total of 274 serum samples were tested, collected from three large farms (n=109) and 109 randomly chosen small farms (n=165). Samples were tested using the PCV type 2 indirect fluorescent antibody test kit by VMRD (USA). Sixty-one percent of the farms tested were positive (2 large farms, 66 small farms). The overall seroprevalence of PCV2 was 62.0% (170/274) and after adjusting for non-proportional sampling between strata, was 70.3% ...

Haematological and serum chemistry reference intervals for categories of pigs in Trinidad and Tobago.

A study was done to establish haematological and serum chemistry reference intervals for nursery pigs (n=120), growers/finishers (n=120), adult non-pregnant, non- lactating female pigs (n=90), mature boars (n=63), pregnant female pigs (n=121), and lactating sows (n=120) in Trinidad and Tobago. Thirty-seven farms were randomly selected for the study. Physical examination was conducted on all animals in order to exclude animals that appeared unhealthy. Blood samples (640 in all) from the pigs were evaluated for haematological and serum chemistry parameters. Reference intervals for the blood parameters were defined by their mean values plus or minus two standard deviations (mean+/- 2 s.d.). The reference limits obtained showed differences among the various age groups and physiological states of the animals, therefore providing an alternative set of reference values to aid in interpretation of data at veterinary laboratories in Trinidad and Tobago.

Haematological and serum chemistry reference intervals for categories of pigs in Trinidad and Tobago.

A study was done to establish haematological and serum chemistry reference intervals for nursery pigs (n=120), growers/finishers (n=120), adult non-pregnant, non- lactating female pigs (n=90), mature boars (n=63), pregnant female pigs (n=121), and lactating sows (n=120) in Trinidad and Tobago. Thirty-seven farms were randomly selected for the study. Physical examination was conducted on all animals in order to exclude animals that appeared unhealthy. Blood samples (640 in all) from the pigs were evaluated for haematological and serum chemistry parameters. Reference intervals for the blood parameters were defined by their mean values plus or minus two standard deviations (mean+/- 2 s.d.). The reference limits obtained showed differences among the various age groups and physiological states of the animals, therefore providing an alternative set of reference values to aid in interpretation of data at veterinary laboratories in Trinidad and Tobago.

Silver nitrate may be far superior to podophyllin in clearing HPV external anogenital warts / El nitrato de plata puede ser muy superior a la podofilina para la eliminación de verrugas anogenitales externas causadas por HPV

Longitudinal data from a case series indicated that clearance rates (95% CIs) of anogenital warts (AGW) by silver nitrate (n = 14) and podophyllin (n = 34) were 93% (79.35, 100) and 14.7% (3, 27) respectively; and RR, 6.31 (95% CI 2.77, 14.37, p = 0.0(5)2), relative benefit increase, 532% (410, 654), and NNT, 1 (1, 2). The total effort needed US$28(BB$56) vs US$598 in 1-3 vs 1-37 visits to achieve one successfully treated patient respectively. While subject to the errors of an open, non-randomized case series, silver nitrate was highly efficacious and cost-effective and should replace podophyllin at the Winston Scot Polyclinic.

Datos longitudinales de una serie de casos indicaron que las tasas de eliminación (95% CI) de verrugas anogenitales (VAG) mediante nitrato de plata (n = 14) y podofilina (n = 34) fueron 93% (79.35, 100); y 14.7% (3, 27) respectivamente; y RR, 6.31 (95% CI 2.77, 14.37, p = 0.0(5)2), aumento relativo de beneficios, 532% (410, 654), y NNT, 1 (1, 2). El esfuerzo total necesitó $28 USD (BB$56) vs $598 USD en 1-3 vs 1-37 visitas para lograr un paciente tratado con éxito respectivamente. Aunque sujeto a los errores de una serie de casos abierta no aleatorizada, el nitrato de plato fue altamente eficaz y costo-efectivo y debe reemplazar la podofilina en Winston Scot Polyclinic.

Silver nitrate may be far superior to podophyllin in clearing HPV external anogenital warts.

Longitudinal data from a case series indicated that clearance rates (95% CIs) of anogenital warts (AGW) by silver nitrate (n = 14) and podophyllin (n = 34) were 93% (79.35, 100) and 14.7% (3, 27) respectively; and RR, 6.31 (95% CI 2.77, 14.37, p = 0.052), relative benefit increase, 532% (410, 654), and NNT, 1 (1, 2). The total effort needed US$28(BB$56) vs US$598 in 1-3 vs 1-37 visits to achieve one successfully treated patient respectively. While subject to the errors of an open, non-randomized case series, silver nitrate was highly efficacious and cost-effective and should replace podophyllin at the Winston Scot Polyclinic.

A possible case of white muscle disease complicated by arthrogryposis and atresia ani in and Anglo Nubian kid in Trinidad and Tobago

There have been many instances of livestock congenital defects in Trinidad and Tobago; however, this case is an interesting one because of the number of defects observed and systems involved in an individual animal. A 2-day-old male Anglo Nubian kid was presented to The University of the West Indies, Faculty of Medical Sciences, School of Veterinary Medicine. The kid was weak, unable to walk, unable to stand and had not suckled since birth, unlike its twin. After detailed physical examination the kid was euthanized and subsequent post mortem examination and histological analysis of tissues revealed atresia ani, numerous muscular defects, severe hepatic necrosis and ankylosis of the joints, strongly suggesting a possible complicated case of White Muscle Disease.

Reasons for stopping antiretrovirals used in an initial highly active antiretroviral regimen: increased incidence of stopping due to toxicity or patient/physician choice in patients with hepatitis C coinfection.

Low adherence and toxicities among HIV-positive patients starting highly active antiretroviral therapy (HAART) can lead to discontinuation of therapy and treatment failure. Little is known about hepatitis C (HCV) status and discontinuation of HAART. Poisson regression was used to determine factors related to discontinuation of any part of an initial HAART regimen due to treatment failure (TF) or toxicities and patient/physician choice (TOX), and to investigate the relationship between HCV and discontinuation of a HAART regimen in 1198 patients staring HAART after 1999 from the EuroSIDA study. At 1 year after starting HAART, 70% of patients remained on their original regimen, 24% had changed, and 6% were off all treatment. The most frequent reason for discontinuation was toxicities (30.4%). There was no change over time in the proportion of patients discontinuing after stratification by reason for discontinuation (p = 0.18). Of patients 190 stopped at least one antiretroviral drug used in their initial HAART regimen due to toxicities; the toxicity reported did not vary according to HCV status (p = 0.90). Anti-HCV seropositive patients had a higher incidence of discontinuation due to TOX (IRR 1.46, 95% CI 1.13-1.88, p = 0.0042) compared to patients without HCV. Patients with HCV were more likely to discontinue all or part of their HAART regimens due to toxicity or patient/physician choice. Managing adverse events must remain a key intervention in maintaining HAART. There is a need for further studies to describe the relationship between HCV, specific antiretrovirals, and different treatment strategies.

Variation in cuticular hydrocarbons among strains of the Anopheles gambiae sensu stricto by analysis of cuticular hydrocarbons using gas liquid chromatography of larvae.

Cuticular hydrocarbons of larvae of individual strains of the Anopheles gambiae sensu stricto were investigated using gas liquid chromatography. Biomedical discriminant analysis involving multivariate statistics suggests that there was clear hydrocarbon difference between the Gambian(G3), the Nigerian (16CSS and, its malathion resistant substrain, REFMA) and the Tanzanian (KWA) strains. The high degree of segregation (95%) in hydrocarbons among the four strains investigated indicates that further analysis is needed to enable understanding of hydrocarbon variation in samples of An. gambiae especially from areas where these populations co-exist.

Coeliac disease in children of West Indian origin.

Coeliac disease is uncommon in populations of non-European origin. Two English born West Indian children with coeliac disease are presented. The diagnosis should be considered in children of West Indian origin with chronic diarrhoea.

Separation of Psychodopygus carrerai carrerai and P. yucumensis (Diptera: Psychodidae) by gas chromatography of cuticular hydrocarbons.

Specimens of two species of sandfly, Psychodopygus carrerai carrerai and P. yucumensis, vectors of Leishmania braziliensis braziliensis in the subandean lowlands of Bolivia, were subjected to cuticular hydrocarbon analysis to ascertain if the technique could separate the females. A high degree of separation (87%) was obtained based on significant differences in the cuticular hydrocarbon composition of these two species. Statistical treatment of the data shows that these species, initially identified by the colour of the mesonotum, can also be distinguished by their hydrocarbons.

Chemical analysis of compounds extracted from the tergal "spots" of Lutzomyia longipalpis from Brazil.

The chemical composition of the compounds contained in the tergal spots of Lutzomyia longipalpis was investigated. Four populations of L. longipalpis were examined, originating from: Sobral, Ceará, Brazil (one spot and two spot populations), Santarém, Pará, Brazil (one spot) and Marajó Island, Pará, Brazil (one spot). The tergal spots were dissected out, extracted in hexane and analysed on a gas chromatograph/mass spectrometer. Two compounds were found, identical to compounds found in earlier studies, but there was no correlation between number of tergal spots and type of compound present. It was suggested that the number of tergal spots could not be used as a marker for reproductively isolated populations, and that analysis of the compound present within the spots might be necessary to characterize potentially good vector populations.