Laboratory assays for determining recent HIV-1 infection are an important public health tool for aiding in the estimation of HIV incidence. Some incidence assay analytes are remarkably predictive of time since seroconversion and may be useful for additional applications, such as predicting recent transmission events during HIV outbreaks and informing prevention strategies.
Abstract Background Misuse of prescription opioid analgesics (POA) has increased dramatically in the US, particularly in non-urban areas. We examined injection practices among persons who inject POA in a rural area that experienced a large HIV outbreak in 2015. Methods Between August-September 2015, 25 persons who injected drugs within the past 12 months were recruited in Scott County, Indiana for a qualitative study. Data from in-depth, semi-structured interviews were analyzed. Results All 25 participants were non-Hispanic white and the median age was 33 years (range: 19–57). All had ever injected extended-release oxymorphone (Opana ® ER) and most (n=20) described preparing Opana ® ER for multiple injections per injection episode (MIPIE). MIPIE comprised 2–4 injections during an injection episode resulting from needing >1mL water to prepare Opana ® ER solution using 1mL syringes and the frequent use of rinse shots. MIPIE occurred up to 10 times/day (totaling 35 injections/day), often in the context of sharing drug and injection equipment. Conclusions We describe a high-risk injection practice that may have contributed to the rapid spread of HIV in this community. Efforts to prevent bloodborne infections among people who inject POA need to assess for MIPIE so that provision of sterile injection equipment and safer injection education addresses the MIPIE risk environment.
The prognosis associated with a new diagnosis of human immunodeficiency virus (HIV) infection has improved dramatically since the virus was first recognized [1]. However, the remarkable increases in survival have been attenuated in some groups because of the presence of comorbid infectious diseases and other illnesses. Globally, an estimated 5%–10% of the 33.3 million people living with HIV are coinfected with the hepatitis B virus (HBV). This double-whammy of HIV/HBV coinfection has translated into poorer outcomes. For instance, in settings where expanded access to antiretroviral therapy (ART) has reduced deaths from HIV, liver-related death (from any of a variety of etiologies) has emerged as an important cause for the remaining mortality [2]. Infection with HIV increases the rate of replication of HBV, thereby accelerating progression to cirrhosis, hepatocellular carcinoma, and other liver-related morbidity [3]. There is not clear evidence that HBV impacts the progression of HIV disease, but it has been speculated that HBV infection increases susceptibility to liver toxicity from ART and impairs the immunological response (eg, CD4 cell–count recovery) to HIV treatment. Evaluating whether HIV progression is an important element of the increased mortality seen in coinfected patients has been challenging because of the heterogeneity of available HIV and HBV data in studies reported to date. The report by Chun et al [4] in this issue of The Journal presents data from the U.S. Military HIV Natural History Study, which evaluates the impact of HBV coinfection on the composite endpoint of AIDS-defining illness or death. To minimize the influence of duration of HIV infection, the analysis was limited to the 2352 cohort participants whose date of HIV seroconversion could be estimated within 3 years, and whose HBV status was known or determined within 2 years of HIV seroconversion (although the timing of their HBV infection was not known). Each patient’s HBV status was classified as either chronic (hepatitis B surface antigen [HBsAg] reactivity), resolved (hepatitis B core antibody [HBcAb] and surface antibody [HBsAb] reactivity with a negative HBsAg), isolated HBcAb (HBcAb reactivity with negative HBsAb and HBsAg), or no evidence of past or current infection (negative HBcAb and HBsAg). Patients classified as having chronic HBV were observed to have a higher risk (approximately double the risk in adjusted analysis) for developing the composite outcome of AIDS-defining illness or death, compared with that of patients who were HBV negative. Hepatitis C virus (HCV) infection was uncommon in this cohort (1.7% of patients had a reactive HCV antibody test), but was also associated with an increased risk of developing an AIDS-defining illness or death. Some strengths of this analysis were the focus on individuals with known dates of HIV seroconversion to minimize survivorship bias, and the classification of HBV status around the HIV seroconversion date to minimize misclassification bias. Although the findings suggest that HBV infection may impact HIV outcomes, as with any cohort study there are methodological limitations that restrict our ability to determine causality. A limitation is that HBV infection directly causes mortality, and these deaths would be counted toward the composite outcome. In both HIV-infected and -uninfected populations, HBV infection is associated with a higher risk of mortality Received 26 September 2011; accepted 26 September 2011; electronically published 5 December 2011. Correspondence: Barbara Marston, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop A-05, Atlanta, GA 30329 (bxm5@cdc.gov). The Journal of Infectious Diseases 2012;205:166–8 Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2011. DOI: 10.1093/infdis/jir728
During the past 15 years, the importance of stray light control and its evaluation as an integral part of the design process for imaging systems has emerged. There has been substantial progress in the development of both analytical tools and experimental facilities. The problem has become easier and more difficult depending on the scenario. Some scenarios such as detecting point objects within a small field of view have made the problem easier as the background stray light is proportional to the field of view. Extended objects and large fields of view make the problem more difficult as does near field thermal sources. It is for these reasons that a review is in order-to assess our present technology and suggest how we might develop that technology.
Background: The JYNNEOS modified vaccinia virus Ankara vaccine has proven effective in preventing clade IIb mpox disease during the ongoing global outbreak associated with sexual transmission. However, understanding of the effect of vaccination on mpox clinical presentation remains limited. Methods: We interviewed cisgender males with confirmed mpox (cases) reported to the California Department of Public Health from May 2022 through December 2023. We ascertained cases' vaccination statuses via the California Immunization Registry. We estimated JYNNEOS vaccine effectiveness against progression (VEP) to disease involving disseminated lesions via the adjusted odds ratio of vaccination, comparing cases who reported lesions disseminated across multiple anatomical regions to cases who reported lesions contained to a single anatomical region. We used the same approach to estimate VEP for prodromal symptoms. Findings: Analyses included 4,613 cases, among whom 3,045 (66.0%) reported disseminated lesions and 1,956 (42.4%) had HIV infection. Among cases who reported disseminated lesions, 114 (3.7%) received pre-exposure vaccination and 43 (1.4%) received post-exposure vaccination only. In contrast, among cases who reported lesions contained to a single anatomical region, 286 (18.2%) received pre-exposure vaccination and 146 (9.3%) received post-exposure vaccination only. For any pre-exposure vaccination, VEP was 58.9% (95% confidence interval: 50.4-65.9%), while VEP for two pre-exposure doses was 61.0% (47.3-71.1%). For post-exposure vaccination, VEP was 15.9% (3.3-26.8%). Among cases without HIV and cases with HIV, pre-exposure VEP was 66.4% (56.6-74.0%) and 45.3% (28.0-58.5%), respectively. Pre-exposure vaccination was also associated with reduced odds for illness involving fever, chills, and lymphadenopathy. Interpretation: Among cisgender males with mpox, pre-exposure vaccination with JYNNEOS is associated with less severe illness. Awareness of an attenuated disease phenotype involving localized lesions without accompanying prodromal symptoms is needed among providers to ensure accurate diagnosis of mpox in previously-vaccinated individuals.
We compared recovery of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) from nasal and groin swab specimens of 600 HIV-infected outpatients by selective and nonselective direct plating and broth enrichment. Swabs were collected at baseline, 6-month, and 12-month visits and cultured by direct plating to mannitol salt agar (MSA) and CHROMagar MRSA (CM) and overnight broth enrichment with subculture to MSA (broth). MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE), staphylococcal cassette chromosome mec (SCCmec) typing, and PCR for the Panton-Valentine leukocidin. At each visit, 13 to 15% of patients were colonized with MRSA and 30 to 33% were colonized with methicillin-susceptible S. aureus (MSSA). Broth, CM, and MSA detected 95%, 82%, and 76% of MRSA-positive specimens, respectively. MRSA recovery was significantly higher from broth than CM (P ≤ 0.001) or MSA (P ≤ 0.001); there was no significant difference in recovery between MSA and CM. MSSA recovery also increased significantly when using broth than when using MSA (P ≤ 0.001). Among specimens collected from the groin, broth, CM, and MSA detected 88%, 54%, and 49% of the MRSA-positive isolates, respectively. Broth enrichment had a greater impact on recovery of MRSA from the groin than from the nose compared to both CM (P ≤ 0.001) and MSA (P ≤ 0.001). Overall, 19% of MRSA-colonized patients would have been missed with nasal swab specimen culture only. USA500/Iberian and USA300 were the most common MRSA strains recovered, and USA300 was more likely than other strain types to be recovered from the groin than from the nose (P = 0.05).
In quantum mechanics, each conserved quantity (e.g., energy, position, linear momentum and angular momentum) is associated with a Hermitian operator. Its expected value can then be determined by performing a measurement on the wavefunction. In modern electron microscopy, one can select the initial and final states of the electron and the measurement basis by performing measurements of scattering processes. For example, the orbital angular momentum (OAM) of an electron can be used to reveal the n-fold symmetry of a wavefunction scattered by a sample. Here, we introduce a new composite planar chirality operator that can be used to measure a spiral-like feature in a sample. This concept develops the concept of chirality to highlight a specific roto-scale symmetry. We show that planar chirality can be characterized using an electron OAM sorter to uncover the atomic structures of biomolecules in cryo electron microscopy, either in a stand-alone analysis for fast identification of protein structures or in the context of conventional cryo electron microscopy to produce faster and more detailed 3D reconstructions by solving upside-down orientation ambiguities.
