Archive for September, 2014

Prevalence of sub-clinical vertebral fractures in HIV-infected patients.

New Microbiol. 2014 Jan;37(1):25-32. Epub 2014 Jan 15.

Borderi M1, Calza L, Colangeli V, Vanino E, Viale P, Gibellini D, Re MC.

Author information

1Infectious Disease Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.


Although the increased prevalence of low bone mineral density among HIV-infected patients has raised concern for increased fracture risk, few investigations have evaluated fracture rates.

Increasing evidence indicates that HIV patients are at higher risk of osteoporotic fractures compared to the general population.

This is a very important issue, because fragility fractures are complications with a significant prognostic value. Our study performed lateral spine X-ray to assess the prevalence of sub-clinical vertebral fractures in 202 HIV patients.

Factors associated with vertebral fractures were also investigated. The prevalence of vertebral fractures was significantly high (23.3%): 14 subjects had SDI (spine deformity index)= 1, 22 SDI=2-3 and 11 SDI >4.

Differences in the prevalence of vertebral fractures between naive and ART experienced patients was 18% vs. 24%, respectively. Furthermore, patients had a high prevalence of severe and multiple fractures; in 19 patients (40%) fractures involved multiple vertebrae.

Patients with vertebral fractures were significantly older, with renal insufficiency and steroid use more frequently than subjects with no fractures.

Our data suggest that the prevalence of vertebral fractures in HIV infection may be higher than expected, and lateral spine X-ray has a role in the screening of bone disease, at least in patients with a significant risk of fragility fractures.


September 30, 2014 at 3:28 pm

Adherence to antiretroviral therapy in adolescents living with HIV – Systematic review and meta-analysis

AIDS August 24, 2014 – Volume 28 – Issue 13

Sung-Hee Kim (a), Sarah M. Gerver (b), Sarah Fidler (c) and Helen Ward (b)

a School of Medicine,

b Infectious Disease Epidemiology, School of Public Health, and

c Communicable Diseases Section, Department of Medicine, Imperial College London, London, UK.

Correspondence to Sung-Hee Kim, Department of Medicine, School of Public Health, Norfolk Place, London W2 1PG, UK. Tel: +44 75009700080; e-mail:


Adolescent and young adult (AYA) populations (12–24 years) represent over 40% of new HIV infections globally. Adolescence is sometimes characterized by high-risk sexual behaviour and a lack of engagement with healthcare services that can affect adherence to antiretroviral therapy (ART). Despite adherence to ART being critical in controlling viral replication, maintaining health and reducing onward viral transmission, there are limited data on ART adherence amongst AYA globally. We undertook a systematic review and meta-analysis of published studies reporting adherence to ART for AYA living with HIV.


Design and methods

Searches included Embase, Medline and PsychINFO databases up to 14 August 2013. Eligible studies defined adequate adherence as at least 85% on self-report or undetectable blood plasma virus levels. A random effects meta-analysis was performed and heterogeneity examined using meta-regression.



We identified 50 eligible articles reporting data from 53 countries and 10725 patients. Using a pooled analysis of all eligible studies, 62.3% [95% confidence interval (CI) 57.1–67.6; I2:97.2%] of the AYA population were adherent to therapy. The lowest average ART adherence was in North America [53% (95% CI 46–59; I2:91%)], Europe [62% (95% CI 51–73; I2:97%)] and South America [63% (95% CI 47–77; I2:85%] and, with higher levels in Africa [84% (95% CI 79–89; I2:93%)] and Asia [84% (95% CI 77–91; I2:0%].



Review of published literature from Africa and Asia indicate more than 70% of HIV-positive AYA populations receiving ART are adherent to therapy and lower rates of adherence were shown in Europe and North America at 50–60%. The global discrepancy is probably multifactorial reflecting differences between focused and generalised epidemics, access to healthcare and funding.



September 30, 2014 at 3:26 pm

Epicardial fat is associated with duration of antiretroviral therapy and coronary atherosclerosis

AIDS July 17, 2014 – Volume 28 – Issue 11

Michael Brenera,M, Kerunne Ketlogetswea,M, Matthew Budoffb,Lisa P. Jacobsonc, Xiuhong Lic, Panteha Rezaeianb, Aryabod Razipourb,Frank J. Palella Jr.d, Lawrence Kingsleye, Mallory D. Wittb,Richard T. Georgea and Wendy S. Posta,cObjective

a Johns Hopkins University School of Medicine, Baltimore, Maryland,

b Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California,

c Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,

d Northwestern University, Chicago, Illinois, and

e University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Correspondence to Wendy S. Post, MD, MS, The Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins Hospital, 600 N. Wolfe St., Carnegie 568, Baltimore, MD 21287, USA. Tel: +1 410 955 7376; fax: +1 443 287 0121; e-mail:



Cytokines released by epicardial fat are implicated in the pathogenesis of atherosclerosis. HIV infection and antiretroviral therapy have been associated with changes in body fat distribution and coronary artery disease. We sought to determine whether HIV infection is associated with greater epicardial fat and whether epicardial fat is associated with subclinical coronary atherosclerosis.



We studied 579 HIV-infected and 353 HIV-uninfected men aged 40–70 years with noncontrast computed tomography to measure epicardial adipose tissue (EAT) volume and coronary artery calcium (CAC). Total plaque score (TPS) and plaque subtypes (noncalcified, calcified, and mixed) were measured by coronary computed tomography angiography in 706 men.



We evaluated the association between EAT and HIV serostatus, and the association of EAT with subclinical atherosclerosis, adjusting for age, race, and serostatus and with additional cardiovascular risk factors and tested for modifying effects of HIV serostatus.



HIV-infected men had greater EAT than HIV-uninfected men (P=0.001). EAT was positively associated with duration of antiretroviral therapy (P=0.02), specifically azidothymidine (P<0.05). EAT was associated with presence of any coronary artery plaque (P=0.006) and noncalcified plaque (P=0.001), adjusting for age, race, serostatus, and cardiovascular risk factors. Among men with CAC, EAT was associated with CAC extent (P=0.006). HIV serostatus did not modify associations between EAT and either CAC extent or presence of plaque.



Greater epicardial fat volume in HIV-infected men and its association with coronary plaque and antiretroviral therapy duration suggest potential mechanisms that might lead to increased risk for cardiovascular disease in HIV.



September 30, 2014 at 3:24 pm

Estimating per-act HIV tranmission risk – Systematic review

AIDS June 19, 2014 V.28 N.10 P.

Pragna Patel, Craig B. Borkowf, John T. Brooks, Arielle Lasry, Amy Lansky and Jonathan Mermin

Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control

and Prevention, Atlanta, Georgia, USA.

Correspondence to Pragna Patel, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA. Tel: +1 404 639 6132; e-mail:


Effective HIV prevention programs rely on accurate estimates of the per-act risk of HIV acquisition from sexual and parenteral exposures. We updated the previous risk estimates of HIV acquisition from parenteral, vertical, and sexual exposures, and assessed the modifying effects of factors including condom use, male circumcision, and antiretroviral therapy.


We conducted literature searches to identify new studies reporting data regarding per-act HIV transmission risk and modifying factors. Of the 7339 abstracts potentially related to per-act HIV transmission risk, three meta-analyses provided pooled per-act transmission risk probabilities and two studies provided data on modifying factors. Of the 8119 abstracts related to modifying factors, 15 relevant articles, including three meta-analyses, were included. We used fixed-effects inverse-variance models on the logarithmic scale to obtain updated estimates of certain transmission risks using data from primary studies, and employed Poisson regression to calculate relative risks with exact 95% confidence intervals for certain modifying factors.


Risk of HIV transmission was greatest for blood transfusion, followed by vertical exposure, sexual exposures, and other parenteral exposures. Sexual exposure risks ranged from low for oral sex to 138 infections per 10 000 exposures for receptive anal intercourse. Estimated risks of HIV acquisition from sexual exposure were attenuated by 99.2% with the dual use of condoms and antiretroviral treatment of the HIV-infected partner.


The risk of HIV acquisition varied widely, and the estimates for receptive anal intercourse increased compared with previous estimates. The risk associated with sexual intercourse was reduced most substantially by the combined use of condoms and antiretroviral treatment of HIV-infected partners.


September 30, 2014 at 3:23 pm

Behavioral Sexual Risk-Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections – An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force

Annals of Internal Medicine Sept.23, 2014

Elizabeth A. O’Connor, PhD; Jennifer S. Lin, MD, MCR; Brittany U. Burda, MPH; Jillian T. Henderson, PhD; Emily S. Walsh, MPH; and Evelyn P. Whitlock, MD, MPH

From Kaiser Permanente Center for Health Research, Portland, Oregon.


Sexually transmitted infections (STIs) are common and preventable.


To update a previous systematic review about the benefits and harms of sexual risk-reduction counseling to prevent STIs for the U.S. Preventive Services Task Force.

Data Sources

Selected databases from January 2007 through October 2013, manual searches of references lists and grey literature, and studies from the previous review.

Study Selection

English-language fair- or good-quality trials conducted in adolescents or adults.

Data Extraction

One investigator abstracted data and a second checked the abstraction. Study quality was dual reviewed.

Data Synthesis

31 trials were included: 16 were newly published (n = 56 110) and 15 (n = 14 214) were from the previous review. Most trials targeted persons at increased risk for STIs based on sociodemographic characteristics, risky sexual behavior, or history of an STI. High-intensity (>2 hours) interventions reduced STI incidence in adolescents (odds ratio, 0.38 [95% CI, 0.24 to 0.60]) and adults (odds ratio, 0.70 [CI, 0.56 to 0.87]). Lower-intensity interventions were generally not effective in adults but some approaches were promising. Although moderate-intensity interventions may be effective in adolescents, data were very sparse. Reported behavioral outcomes were heterogeneous and most likely to show a benefit with high-intensity interventions at 6 months or less. No consistent evidence was found that sexual risk-reduction counseling was harmful.


Low-risk populations and male adolescents were underrepresented. Reliability of self-reported behavioral outcomes was unknown.


High-intensity counseling on sexual risk reduction can reduce STIs in primary care and related settings, especially in sexually active adolescents and in adults at increased risk for STIs.

Primary Funding Source

Agency for Healthcare Research and Quality.


September 26, 2014 at 8:23 am

Ceftaroline in Combination With TMS for Salvage Therapy of MRSA Bacteremia and Endocarditis

Journal of Infectious Diseases Summer 2014 V.1 N.2

Brief Report

Valeria Fabre1, Marcela Ferrada1,4, Whitney R. Buckel2, Edina Avdic3 and Sara E. Cosgrove1

1Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland

2Department of Pharmacy, Intermountain Medical Center, Murray, Utah

3Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland

4Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland

Correspondence: Valeria Fabre, MD, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street Room 450B, Baltimore, MD 21205. (

No clinical trials have investigated the use of ceftaroline fosamil for salvage therapy of methicillin-resistant Staphylococcus aureus bacteremia and endocarditis.

We report data on 29 patients who received ceftaroline ± another antimicrobial for this indication.

Ninety percent of patients had microbiologic cure and 31% had treatment success with a median follow-up of 6 months.


September 25, 2014 at 3:58 pm

Bone loss in the HIV-infected patient – Evidence, clinical implications, and treatment strategies.

J Infect Dis. 2012 Jun;205 Suppl 3:S391-8.

Walker Harris V1, Brown TT.

Author information

1Division of Endocrinology, Johns Hopkins University School of Medicine,1830 EMonument Street, Baltimore, MD 21287, USA.


Osteoporosis is common in human immunodeficiency virus (HIV)-infected persons.

The etiology of osteoporosis in HIV-infected patients is likely multifactorial, involving traditional risk factors such as low body weight, hypogonadism, and smoking, as well as direct effects of chronic HIV infection and antiretroviral therapy.

Emerging evidence suggests that the increasing prevalence of osteoporosis in HIV-infected persons translates into a higher risk of fracture, likely leading to excess morbidity and mortality as the HIV-infected population ages.

This review addresses the epidemiology of osteoporosis, discusses the causes of low bone mineral density in HIV-infected persons, including the impact of specific antiretroviral therapies, and offers recommendations on screening and treating vitamin D deficiency and osteoporosis.



September 25, 2014 at 3:55 pm

Ebola virus disease in West Africa — the first 9 months of the epidemic and forward projections

N Engl J Med 2014 Sep 23

WHO Ebola Response Team.


On March 23, 2014, the World Health Organization (WHO) was notified of an outbreak of Ebola virus disease (EVD) in Guinea. On August 8, the WHO declared the epidemic to be a “public health emergency of international concern.”


By September 14, 2014, a total of 4507 probable and confirmed cases, including 2296 deaths from EVD (Zaire species) had been reported from five countries in West Africa — Guinea, Liberia, Nigeria, Senegal, and Sierra Leone. We analyzed a detailed subset of data on 3343 confirmed and 667 probable Ebola cases collected in Guinea, Liberia, Nigeria, and Sierra Leone as of September 14.


The majority of patients are 15 to 44 years of age (49.9% male), and we estimate that the case fatality rate is 70.8% (95% confidence interval [CI], 69 to 73) among persons with known clinical outcome of infection. The course of infection, including signs and symptoms, incubation period (11.4 days), and serial interval (15.3 days), is similar to that reported in previous outbreaks of EVD. On the basis of the initial periods of exponential growth, the estimated basic reproduction numbers (R0 ) are 1.71 (95% CI, 1.44 to 2.01) for Guinea, 1.83 (95% CI, 1.72 to 1.94) for Liberia, and 2.02 (95% CI, 1.79 to 2.26) for Sierra Leone. The estimated current reproduction numbers (R) are 1.81 (95% CI, 1.60 to 2.03) for Guinea, 1.51 (95% CI, 1.41 to 1.60) for Liberia, and 1.38 (95% CI, 1.27 to 1.51) for Sierra Leone; the corresponding doubling times are 15.7 days (95% CI, 12.9 to 20.3) for Guinea, 23.6 days (95% CI, 20.2 to 28.2) for Liberia, and 30.2 days (95% CI, 23.6 to 42.3) for Sierra Leone. Assuming no change in the control measures for this epidemic, by November 2, 2014, the cumulative reported numbers of confirmed and probable cases are predicted to be 5740 in Guinea, 9890 in Liberia, and 5000 in Sierra Leone, exceeding 20,000 in total.


These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from EVD are expected to continue increasing from hundreds to thousands per week in the coming months.


September 25, 2014 at 3:52 pm

The Ebola emergency — immediate action, ongoing strategy.

N Engl J Med 2014 Sep 23

Farrar JJ and Piot P

The 25th known outbreak of Ebola virus infection is unlike any of the previous epidemics. It has already killed over 2800 people — more than all previous epidemics combined; it’s affecting virtually the entire territory of three countries, involving rural areas, major urban centers, and capital cities; it has been going on for almost a year; and it is occurring in West Africa, where no Ebola outbreak had previously occurred.

Above all, the epidemic seems out of control and has evolved into a major humanitarian crisis that has finally mobilized the world, with responses ranging from an emergency health mission launched by the United Nations Security Council to proposed military-style interventions and the global provision of emergency aid….



September 25, 2014 at 3:51 pm

Alternative Screening Approaches for Discovery of Middle East Respiratory Syndrome Coronavirus Inhibitors

Antimicrobial Agents and Chemotherapy AUG  2014 V.58 N.8 P.4251-4252

Robert L. LaFemina

Editor, Antimicrobial Agents and Chemotherapy, Schwenksville, Pennsylvania, USA

Two coronaviruses causing severe respiratory disease and high mortality rates emerging within the past dozen years reinforces the need for clinically efficacious antivirals targeting coronaviruses.

Alternative screening approaches for antivirals against the recently emergent Middle East respiratory syndrome coronavirus (MERS-CoV) may provide lead compounds to address this need.

Two Antimicrobial Agents and Chemotherapy (AAC) papers screened libraries of approved compounds that may potentially be repurposed as MERS-CoV antivirals.

A third AAC paper showed that a previously described severe acute respiratory syndrome coronavirus (SARS-CoV) helicase inhibitor also has activity against MERS-CoV.


September 24, 2014 at 8:16 pm

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