Clinicopathological Characteristics and Outcomes of Anal Squamous Cell Carcinoma Patients With and Without HIV Infection in Sub-Saharan Africa
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PURPOSE In the past 20 years, the burden of anal cancer (AC) increased by 60% in the United States and over three-fold in Africa. Rates of AC have increased by 20× in people living with HIV and the highest (50×) in men with HIV who have sex with men. However, in sub-Saharan Africa (SSA) where HIV is endemic, data on clinicopathological characteristics and outcomes of patients with AC are lacking. To address this, we have investigated AC disease presentation, treatment outcomes, and its predictors in a cohort of patients who were either HIV-infected or HIV-uninfected in SSA. METHODS We conducted a retrospective cohort study of patients with anal squamous cell carcinoma (SCC) treated at Ocean Road Cancer Institute in Dar es Salaam, Tanzania from January 2014 to December 2019. Associations between the study outcomes and their predictors were analyzed using univariate and multivariate analysis models. RESULTS A total of 59 patients with anal SCC were retrieved and had at least 2-year follow-up. The mean age was 53.9 (standard deviation ±10.5) years. While none of the patients presented with stage I disease, 64.4% had locally advanced disease. HIV infection was the major comorbidity (64.4%). The rate of complete remission at the end of treatment was at 49% while the 2-year overall survival (OS) and local recurrence-free survival were 86.4% and 91.3%, respectively. Despite high HIV coinfection in the cohort, AC treatment outcomes were not significantly associated with HIV status. Disease stage ( P = .012) and grade ( P = .030) were significantly associated with 2-year OS. CONCLUSION Patients with anal SCC in Tanzania present mainly with locally advanced disease associated with high HIV prevalence. In this cohort, the SCC grade was independently associated with treatment outcomes unlike other factors such as HIV coinfection.Two or more viruses infecting the same host cell can interact in ways that profoundly affect disease dynamics and control, yet the factors determining coinfection rates are incompletely understood. Previous studies have focused on the mechanisms that viruses use to suppress coinfection, but recently the phenomenon of enhanced coinfection has also been documented. In the experiments described here, we explore the hypothesis that enhanced coinfection rates in the bacteriophage Φ6 are achieved by virus-induced upregulation of the Φ6 receptor, which is the bacterial pilus. First, we confirmed that coinfection enhancement in Φ6 is virus-mediated by showing that Φ6 attaches significantly faster to infected cells than to uninfected cells. Second, we explored the hypothesis that coinfection enhancement in Φ6 depends upon changes in the expression of an inducible receptor. Consistent with this hypothesis, the closely related phage, Φ12, that uses constitutively expressed lipopolysaccharide as its receptor, attaches to infected and uninfected cells at the same rate. Our results, along with the previous finding that coinfection in Φ6 is limited to two virions, suggest that viruses may closely regulate rates of coinfection through mechanisms for both coinfection enhancement and exclusion.
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Studies have reported coinfection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the cause of coronavirus disease-2019 (COVID-19), with other viruses that cause respiratory tract infections (RTIs). We investigated the coinfection rate of SARS-CoV-2 and other RTI-causing viruses, and whether the cycle threshold (Ct) value of a real-time reverse transcriptase PCR (RT-PCR) differed when the coinfection occurred during the first wave of COVID-19 in Daegu, Republic of Korea, in 2020.After performing PCR for SARS-CoV-2, we additionally tested for the presence of RTI-causing viruses to check for coinfection. Subsequently, we identified the specific coexisting respiratory viruses and calculated the coinfection rate. In addition, based on the coinfection status, we compared the Ct values obtained from RT-PCR for SARS-CoV-2 in patients who tested positive for COVID-19 PCR.Of 13,717 patients, 123 had positive results on COVID-19 PCR testing and six tested positive for an RTI-causing virus. Thus, the coinfection rate was 4.9%. There were no statistically significant differences in the mean Ct values of SARS-CoV-2 RT-PCR between coinfected and non-coinfected patients.This study computed the coinfection rate of SARS-CoV-2 and RTI-causing viruses and revealed that the mean Ct values in SARS-CoV-2 real-time RT-PCR did not differ according to the coinfection status.
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In developing countries, Tuberculosis is the commonest coinfection to occur in HIV positive patients and is supposed to impact the treatment outcome in patients on antiretroviral therapy. This prospective study was conducted in Department of Microbiology, PGIMS Rohtak to study the effect of coinfection with TB on Virological Failure in patients on first line of Highly Active Antiretroviral Therapy. A total of 50 patients on first line of HAART and suffering from Immunological Failure were chosen and were evaluated for Tuberculosis. Plasma viral load of these patients was done to find Virological Failure patients and the effect of coinfection with TB on Virological Failure was studied. Out of 50 patients with Immunological Failure, 17(34%) had HIV-TB coinfection. Eight out of 50 patients had Virological Failure and coinfection with TB was seen in 7 (87%) out of 8 Virological Failure patients. The occurrence of Virological Failure is more likely if the patient has coinfection with TB. Prevention and timely treatment of this coinfection is vital to prevent the development of Virological Failure.
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Background: Coinfection by Dengue and Malaria is not uncommon,though studies are scarce. Both remain among the major causes of acute febrile illnesses in India. The objective of this study is to understand and observe the interplay of Dengue and Malaria,compare their clinical and laboratory features and analyze the outcomes. Methods & Materials: A comparative, retrospective study of Dengue, Malaria and their coinfections was carried out, during 2 consecutive monsoons (June-November;2014 and 2015), in a Mumbai hospital. Febrile patients,during this period,were investigated for both Dengue and Malaria simultaneously. Elisa(NS-1/IgM) and peripheral smear examination was done to confirm Dengue and Malaria respectively. Clinical comparison of signs and symptoms,severity and outcomes, as per predefined criteria was systematically carried out.. Relevant laboratory parameters were compared. Results: During 2014,of 156 included febrile cases,85(54.48%) were Dengue monoinfection,55(35.25%) isolated Malaria and 16(10.25%) coinfection cases,whereas in 2015, of 417 febrile cases,272(65.2%)were Dengue,117(28.05%) isolated Malaria and 28(6.7%) were coinfection cases. The coinfection and Dengue groups presented with a similar clinical picture. Among compared laboratory parameters,transaminitis was statistically significant in the coinfection group(p<0.001). Anaemia was significant in the Malaria group,whereas,the Dengue group presented with raised haematocrit and thrombocytopenia. The coinfection group, with low haemoglobin and haematocrit, was consistent with concurrent Malaria coinfection. Among compared severity parameters,bleeding manifestations,renal dysfunction and jaundice, was notable in the coinfection group,compared to the Malaria group(12% & 3.6% and 6.3% & 3.6% each respectively) with 3 mortalities in the Malaria and 1 in the coinfection group during 2014. During 2015,despite increased Dengue and coinfection cases,numerically, with increased jaundice and bleeding manifestations(16% &8% and 8% & 6% respectively),recovery was total. Conclusion: Dual infection by Dengue and Malaria was observed by us, for the first time, in 2014. This phenomenon,was noticed to recur, subsequently,during 2015. as well; and therefore merits further studies. Awareness and thus routine testing for both,helps in effective management and reducing mortality as observed.
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Abstract Infection of more than one virus in a host, coinfection, is common across taxa and environments. Viral coinfection can enable genetic exchange, alter the dynamics of infections, and change the course of viral evolution. Yet, a systematic test of the factors explaining variation in viral coinfection across different taxa and environments awaits completion. Here I employ three microbial data sets of virus-host interactions covering cross-infectivity, culture coinfection, and single-cell coinfection (total: 6,564 microbial hosts, 13,103 viruses) to provide a broad, comprehensive picture of the ecological and biological factors shaping viral coinfection. I found evidence that ecology and virus-virus interactions are recurrent factors shaping coinfection patterns. Host ecology was a consistent and strong predictor of coinfection across all three datasets: cross-infectivity, culture coinfection, and single-cell coinfection. Host phylogeny or taxonomy was a less consistent predictor, being weak or absent in the cross-infectivity and single-cell coinfection models, yet it was the strongest predictor in the culture coinfection model. Virus-virus interactions strongly affected coinfection. In the largest test of superinfection exclusion to date, prophage sequences reduced culture coinfection by other prophages, with a weaker effect on extrachromosomal virus coinfection. At the single-cell level, prophage sequences eliminated coinfection. Virus-virus interactions also increased culture coinfection with ssDNA-dsDNA coinfections >2x more likely than ssDNA-only coinfections. The presence of CRISPR spacers was associated with a ~50% reduction in single-cell coinfection in a marine bacteria, despite the absence of exact spacer matches in any active infection. Collectively, these results suggest the environment bacteria inhabit and the interactions among surrounding viruses are two factors consistently shaping viral coinfection patterns. These findings highlight the role of virus-virus interactions in coinfection with implications for phage therapy, microbiome dynamics, and viral infection treatments.
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Coinfection with HIV and hepatitis C virus (HCV) is a serious medical and social problem. As shown in some of the latest studies, if people with HIV are at about twice and those with HCV are at thrice the risk for death compared with healthy people, those with both infections are at almost 5 times the risk for it [1]! With that in mind the optimal choice of therapy regimens for patients with coinfection takes on particular and extremely important significance.
Hepatitis C
Hepatitis virus
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Comorbidity may be an important reason for head and neck surgeons to treat elderly patients less intensively. This article provides an overview of the influence of age and comorbidity on choice of therapy, postoperative complications, and survival.Several retrospective studies show that elderly patients can undergo surgery if they do not have severe comorbid disorders. Severe comorbidity influences the rate of postoperative complications, and the higher complication rate in older patients reported in some studies is probably due to a higher level of comorbidity. Comorbidity also affects the survival of cancer patients, but several studies have failed to detect a relation between age and survival after correction for comorbidity. Thus, although severe comorbidity may influence the choice of treatment, patient age as such should not be a reason to exclude patients from intensive therapy.If severe comorbidity is not present, elderly patients should receive standard treatment for head and neck cancer. Treatment choice should be based on medical findings and patient preference, not on chronologic age.
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Coinfections have a potential role in increased morbidity and mortality rates during pandemics. Our investigation is aimed at evaluating the viral coinfection prevalence in COVID-19 patients.
2019-20 coronavirus outbreak
Betacoronavirus
Coronavirus Infections
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Many fundamental patterns of coinfection (multi-species infections) are undescribed, including the relative frequency of coinfection by various pathogens, differences between single-species infections and coinfection, and the burden of coinfection on human health. We aimed to address the paucity of general knowledge on coinfection by systematically collating and analysing data from recent publications to understand the types of coinfection and their effects.From an electronic search to find all publications from 2009 on coinfection and its synonyms in humans we recorded data on i) coinfecting pathogens and their effect on ii) host health and iii) intensity of infection.The most commonly reported coinfections differ from infections causing highest global mortality, with a notable lack of serious childhood infections in reported coinfections. We found that coinfection is generally reported to worsen human health (76% publications) and exacerbate infections (57% publications). Reported coinfections included all kinds of pathogens, but were most likely to contain bacteria.These results suggest differences between coinfected patients and those with single infections, with coinfection having serious health effects. There is a pressing need to quantify the tendency towards negative effects and to evaluate any sampling biases in the coverage of coinfection research.
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The HAART therapy has improved life expectancy enabling long latency conditions caused by the hepatitis viruses that became the leading cause of death in HIV infected patients. In this study a group of 300 patients aged from 18 to 63 years were selected in order to assess the prevalence and consequences of HIV and the hepatitis B (HBV), C (HCV) and D (HDV) viruses coinfections. Study groups were designed for each coinfection. These groups were in turn divided in case groups formed of coinfected participants and control groups consisting of mono-infected participants. This classification was obtained by testing the participants for the presence of specific infection markers using the ELISA technique. As a result, in regard to the HIV/HBV coinfection the study group consisted of 16 coinfected participants and 114 HBV-infected participants resulting in a prevalence of the coinfection of 14%. In the case of the HIV/HDV coinfection the study group consisted of 5 coinfected participants and 45 HDV-infected participants. The prevalence of the HIV/HCV coinfection was 25% out of the 170 HCV-infected participants. The effect of the coinfections on the expression and levels of the infection markers was analyzed in constrast to those encountered in the case of the mono-infection. The observed changes in the expression of the specific hepatitis markers indicate the impact of the coinfection with HIV on the progression of the hepatitis infections. In addition, the inadequate immune response towards the hepatitis viruses in the case of the coinfected participants leads to the development of cirrhosis and end stage liver disease.
Hepatitis B
Hepatitis C
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