bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3-S2.02 Variations in testing and treatment received by infants with possible neonatal herpes
Authors: Meites E , Xu F , Hutchins K , Ackerson B , Gee J , Eriksen E , Naleway A , Markowitz L , Zangwill K 
Published: July 2011

BackgroundData are scarce on clinical care of infants with possible neonatal herpes simplex virus (HSV) infection, a rare and serious condition that should be treated with systemic acyclovir for 14–21 days. We reviewed HSV testing and treatment in a large cohort of US infants in order to assess clinical care received.MethodsWe investigated >270 000 infants born from 1997 to 2002 at three managed care organizations participating in the US Vaccine Safety Datalink. Medical records were abstracted if an infant had a discharge ICD-9 code compatible with HSV infection, a positive laboratory test for HSV, or neonatal death. Abstracted data included symptoms, testing, and treatment. Two physicians reviewed likely HSV infections. We identified confirmed cases (compatible symptoms and positive laboratory test), probable cases (compatible symptoms only), and others (with an alternate diagnosis). Descriptive frequencies were calculated.ResultsWe abstracted records from 770 infants, identifying 35 cases (24 confirmed and 11 probable) and 735 others. HSV infection manifested as skin, eye, and mucosal (SEM) disease in 20 cases, central nervous system (CNS) disease in 8 cases, and disseminated disease in seven cases. Among 35 cases, all 35 (100%) had symptoms compatible with HSV infection; these included vesicular lesions in 20 (57%) and seizure in 7 (20%). Overall, 35 (100%) were ever tested for HSV. At least 34 (97%) received some acyclovir; median time to treatment, available for 32 cases, was 3 days (range 0–35 days). Only 8 (23%) received systemic acyclovir for the recommended 14–21 days, while 18 (51%) received <14 days and 8 (23%) received more than 21 days. Among 735 others, 701 (95%) had symptoms compatible with HSV infection; these included vesicular lesions in 10 (1%) and seizure in 244 (33%). Overall, 172 (23%) were ever tested for HSV, including 7/10 (70%) with vesicular lesions and 69/244 (28%) with seizure. At least 98 (13%) received some acyclovir, including 2/10 (20%) with vesicular lesions and 18/244 (7%) with seizure. Of these, 32 (4%) infants received acyclovir for ≥7 days.ConclusionsOur results reveal variations in clinical care of infants with possible neonatal HSV infection. Among cases, duration of antiviral therapy rarely followed treatment recommendations. Among symptomatic infants, most with vesicular lesions but few with seizures were ever tested for HSV. These variations suggest opportunities for clinical quality improvements.
P3-S2.04 Clinical evaluation of the BD HSV2 Qx assay for the direct qualitative testing of HSV2 as compared to viral culture and a laboratory-based PCR assay using male and female external anogenital lesions
Authors: Hires L , Van Der Pol B , Williams J , Corey L , Hook E W , Nye M , Taylor S , Martens M , Mena L , Warren T 
Published: July 2011

BackgroundTo compare the performance characteristics of the BD ProbeTecTM HSV2 Qx Assay* on the BD ViperTM System in Extracted Mode to viral culture and a well-characterised molecular assay for the detection of HSV2. External anogenital lesions were sampled with two different collection devices: a universal viral transport (UVT) kit and a BD Qx swab (QS) kit*.MethodsEleven geographically diverse clinical centers participated in the study, with nine of the sites enrolling participants. The UVT was collected first followed by the QS specimen. A portion of each UVT specimen was transferred to a Qx Diluent Tube (diluted UVT) and a cryovial. The remainder of the UVT in the original tube was frozen at −70°C and sent to one of two sites for HSV viral culture using the ELVIS®HSV ID and D3 Typing Test System (Diagnostic Hybrids, Inc). The diluted UVT and QS specimens were shipped to one of three sites for HSV testing on the BD Viper. The UVT aliquot in the cryovial was stored at −70°C and shipped to the University of Washington for PCR testing for HSV.ResultsSubjects (n=508) were enrolled between February and August of 2010 with 501 UVT and 498 QS samples available for comparison to ELVIS culture, and 506 and 503 samples, respectively, for comparison to the PCR assay. The sensitivity and specificity of the BD HSV2 Qx Assay were compared to ELVIS culture and the positive (PPA) and negative (NPA) per cent agreement of the assay was compared to the HSV PCR assays for both specimen types. Of the BD HSV2 Qx Assay positive, culture negative samples, 46/51 (90.2%) of the UVT and 49/60 (81.7%) of the QS were positive by HSV2 PCR see Abstract P3-S2.04 table 1.Abstract P3-S2.04 Table 1HSV2Specimen typeHSV2 Qxassay performanceCompared to ELVIS HSV2 cultureCompared to HSV2 PCR assaySensitivitySpecificityPPANPADiluted UVT98.4% (186/189)83.7% (261/312)97.5% (237/243)98.1% (258/263)QxSwab (QS)98.4% (186/189)80.6% (249/309)98.8% (240/243)95.8% (249/260)ConclusionsThe BD HSV2 Qx Assay on the BD Viper had excellent agreement with the lab developed PCR assay for diagnosis of HSV2, which is currently recognised as one of the best available tests for the detection of HSV. A commercially available molecular-based assay for the detection of HSV would not only improve detection and reduce turn-around time on results, but may also obviate the need for stringent transport conditions required for HSV culture. *Product not for sale, for investigational use only in the USA.
P1-S1.45 Neisseria gonorrhoeaeantimicrobial susceptibility in Latin America and the Caribbean (2000–2009) - a contribution to the treatment guidelines revision
Authors: Starnino S , Liao M , Ruben M , Storey A , Dillon J A R ,   GASP-LAC Network
Published: July 2011

BackgroundActive surveillance of the antimicrobial susceptibility (AS) ofNeisseria gonorrhoeae(Ng) isolates was carried out by the Gonococcal Antimicrobial Surveillance Program (GASP) in Latin America and the Caribbean (LAC) during the 1990s. A retrospective analysis of surveillance activities undertaken during the 2000s was conducted to describe trends in Ng AS and to re-initiate the GASP network.MethodsNg isolates were collected and tested for AS to penicillin (Pen), tetracycline (Tet), ciprofloxacin (Cip), ceftriaxone (Cef), azithromycin (Azi) and spectinomycin (Spe) in 11 countries between 2000 and 2009. Agar dilution, disc diffusion and Etest methods were used as described by CLSI and previously established in the GASP-LAC network. Trends in AS were retrospectively analysed in each country and aggregated at the GASP-LAC Co-ordinating Centre.Results6 countries collected data over the entire study period and five countries tested for AS sporadically. In total, 9026 Ng isolates were tested. Cip resistance first appeared in 2000 with 2%, (19/784) and resistant per cent increased to 30% (297/975) in 2009. Cip resistance was observed in 10 countries. Azi resistance per cent increased from 6% (41/646) in 2000 to 27% (224/842) in 2009; one country reported no resistance. Pen resistance per cents ranged between 29% (299/1035) in 2000 and 33% (256/772) in 2006. Tet resistance percents declined from 61% (633/1041) in 2000 to 35% (323/931) in 2009. The majority of Ng isolates were susceptible to Cef and Spe. However, 7/110 isolates showed decreased susceptibility to Cef in one country in 2007 and 2/25 isolates showed intermediate susceptible to Spe in another country in 2009.ConclusionsCip for primary treatment of uncomplicated gonococcal infections is currently recommended in 10 of the 11 countries, 1 country recommended Cef in 2007. The emergence and spread of resistance to Cip and Azi, indicate that current treatment guidelines be reviewed using respective national antimicrobial surveillance data. The emergence of a few strains with reduced susceptibility to third-generation cephalosporins indicates that on-going GASP surveillance is warranted.
P3-S3.05 Cotrimoxazole resistant respiratory opportunistic pathogens in HIV and AIDS patients in Lagos, Nigeria
Authors: Idika N , Anidobe M , Onwujekwe D , Idigbe O 
Published: July 2011

IntroductionOpportunistic infections, viral, bacterial, fungal and parasitic are the most common cause of morbidity and mortality in HIV patients. Of the different antibiotics used for bacterial respiratory tract infections, cotrimoxazole appears to be a drug of choice in most developing countries because of its very low cost. Studies in Ivory Coast showed that cotrimoxazole decreased hospitalisation in 50% of all HIV patients and decreased mortality by 50% when given to HIV positive TB patients. RecentlyStreptococus pneumoniae,Haemophilus influenzae,Moraxalla catarrhalishave become increasingly resistant to antibiotics and the rates vary between countries. Aware of the public health importance, the drug resistance patterns on bacterial respiratory opportunistic pathogens from HIV patients in Lagos were studied for better management of HIV in Nigeria.Methods310 sputum samples were collected from HIV patients presenting with respiratory complaints at ART clinics in Lagos after due informed consent from the patients and processed in the laboratory within 4 h using standard microbiological methods.Results57.1% patients were females, 70.5% of the samples grew bacterial pathogens mainlyMorascella catarrholis25.1%,Staphylococcus aureus9.2%,Streptococcus pneumoniae8.3%,Pseudomonas aeruginosa7.3%, coaggulase negative staphylococcus 5.3%. Some Enterobactereciae were isolated and 86.8% of isolates were susceptible to ofloxacin, 80.2% to ciprofloxacin and 12.8% to cotrimoxazole.ConclusionPathogens isolated were susceptible to ofloxacin, ciprofloxacin but highly resistant to cotrimoxazole, an affordable and widely used drug in African countries. This poses a challenge to management of HIV in Nigeria.
P3-S3.09 New drugs targeting toxicities have highest hope of impacting patient prognosis
Authors: Smit M , Smit C , Cremin I , Hallett T , de Wolf F , Garnett G 
Published: July 2011

BackgroundAs more HIV drugs enter the market there is a need to evaluate the effect of various antiretroviral therapies (ART) on patient outcomes. We aim to quantify the impact of different first- and second-line ART strategies on patient outcome including TMC278, an investigative non-nucleoside reverse-transcriptase inhibitors, thought to have low toxicity rates.MethodsA deterministic model was developed representing a cohort of 100 000 HIV-infected individuals. The model was parameterised using data from Athena; a cohort encompassing all patients infected with HIV-1 followed longitudinally since 1996 at 25 HIV treatment centres in the Netherlands. Clinical, biological and immunological data for HIV-infected patients are collected upon entry and at each follow-up visit. The model allows comparison of different ART strategies and of the impact of adverse outcomes: (I) toxicity; (II) general failure and (III) resistance on time on ART and life-years saved per person treated.ResultsOne of the main reasons for switching treatment is toxicity; therefore, new drugs aimed at reducing toxicity will be valuable. The model shows that if TMC278 can reduce incidence of toxicity leading to discontinuation of first-line ART from 74 to 49 per 1000 patients per year (34%) compared with current treatment then this would equate to one additional life-year saved per patient (Abstract P3-S3.09 figure 1). In comparison, a reduction in general failure from 38 to 25 incidences per 1000 patients per year (34%) adds 6 months and a reduction in resistance from 13 to 1 incidence per 1000 patients per year (92%) adds only 5 months (Abstract P3-S3.09 figure 1). For second-line, reducing incidence of toxicity from 143 to 53 per 1000 patients per year (63%) will add one life-year to per patient. This compares favourably with empirical estimates of toxicity for TMC278 in clinical trials (70% reduction in toxicity leading to discontinuation of first-line ART compared with efavirenz). The model also shows that by reducing rates of toxicity for first-line ART, consequently improving patient prognosis, patients on average spend more time on first-line ART before switching. Decreasing toxicity by 34% equates to an additional 18 months on first-line ART and a 61% decrease in toxicity equates to about five additional years on first-line ART.Abstract P3-S3.09 Figure 1Increase in life-expectancy per person treated with reduced annual incidence of adverse outcomes per 1000 patients for first-line ART. The red markers indicate empirical data; the blue markers indicate simulated estimates.ConclusionsNew drugs which target a reduction in toxicities have the highest impact on patient prognosis, and such drugs are within reach of current candidate products.
P1-S1.46 Syphilis trends in Zambia - a 14-year observation
Authors: Makasa M , Fylkesnes K , Sandoy I 
Published: July 2011

BackgroundSyphilis and other STIs are prevalent in sub-Saharan Africa, perhaps due to lack of effective curative services. Estimates among pregnant women and in the general population in Zambia range from 6% to 18%, with maternal syphilis contributing to a high number of mid-trimester abortions, still births, prematurity, and morbidity and mortality of the child. Existing evidence suggests that control of syphilis and other ulcerative and non-ulcerative STIs remains one of the key strategies for HIV control. There are no recent studies from Zambia comparing syphilis prevalence with HIV trends.ObjectivesTo investigate trends in syphilis prevalence using Antenatal Clinic (ANC) sentinel surveillance data, and to validate the findings with population-based data.MethodsThe analyses are based on ANC data from 1994 to 2008 from 22 sites. Estimates are compared with data from Zambia Demographic and Health Surveys (ZDHS) 2001/2002 and 2007. Analyses were restricted to women aged 15–49 years and 15–24 years. ORs with 95% CIs were used to test whether the prevalence trends were significant.ResultsThe overall syphilis prevalence dropped during the period 1994–2008 among both urban and rural women aged 15–49 years from 9.8% to 2.8% and 7.5% to 3.2%, respectively. Provincial variation was observed with a tendency towards a reduction. A sharper decline in syphilis prevalence was observed among women with more years in school than among those with fewer schooling years. A declining trend was also seen among young primi gravid women aged 15–19 years. A comparison of ZDHS 2001/2002 and 2007 findings also showed an overall reduction in syphilis prevalence in the general population.ConclusionsThere was an overall reduction in syphilis prevalence and this decline was sharper than the decline in HIV during the same period. In part this could be attributed to the revamping of STI services in the country. Reduction in both HIV and syphilis prevalence could also suggest a reduction in the disease incidence and is likely to partially reflect positive sexual behaviour changes. Provincial variations were striking and need to be further studied to better guide specific STI prevention and control programmes in different geographical settings.
P3-S3.12 Transmitted HIV drug resistance mutations in Ontario, Canada, 2002–2009
Authors: Burchell A , Bayoumi A , Major C , Gardner S , Taylor D , Rachlis A , Sandstrom P , Rourke S , Brooks J 
Published: July 2011

BackgroundWe estimated the prevalence of transmitted HIV drug resistance (TDR) among HIV-positive outpatients in Ontario, Canada who were diagnosed since 2002 when the provincial laboratories started testing for drug resistance among treatment-naïve patients.MethodsWe analysed data from the Ontario HIV Treatment Network Cohort Study, a multi-site open dynamic cohort of people living with HIV. Participants were recruited from specialised HIV clinics and primary care practices. Data were obtained from medical chart extractions, interviews and linked with data from the Ontario Public Health Laboratories, which performs almost all viral load and genotypic resistance testing (GRT). We analysed data from participants who received GRT testing while treatment-naïve, defined as (1) no record of antiretroviral use in their clinical chart and (2) detectable viral load. We used the Stanford University HIV Drug Resistance Database to identify TDR mutations in the viral sequences of the protease and reverse transcriptase genes. We used descriptive statistics to characterise the prevalence of TDR mutations and report results with 95% CI.ResultsAmong 623 persons diagnosed in 2002–2009, 330 received GRT while treatment naïve. Among those tested, the mean age was 39 (SD 9.9); 12% were female, 65% men who have sex with men (MSM), and 66% white. The median baseline viral load count was 4.5 log10 copies/ml (IQR 3.9–5.0) and the median baseline CD4 count was 399 cells/mm3(IQR 240–540). Overall, 13.6% (CI 9.9 to 17.3%) had one or more drug resistance mutations, and 8.8% (CI 5.7 to 11.8%), 4.8% (CI 2.5 to 7.2%) and 2.7% (CI 1.0 to 4.5%) had mutations conferring resistance against nucleoside/tide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), or protease inhibitors (PIs), respectively. TDR against two or more drug classes was observed in 2.7% (CI 1.0 to 4.5%). The most common mutations were T215 revertants, M41L, and K103N in the RT gene. The proportion with TDR was highest among IDU (30.4%), intermediate among MSM and heterosexuals (12.0% and 14.3%, respectively) and lowest among persons from HIV endemic regions (6.9%) (p=0.06). Participants diagnosed in 2008–2009 had a higher proportion of NRTI mutations (18.2% vs 5.9%, p=0.0009) and NNRTI mutations (11.7% vs 2.8%, p=0.004) than those diagnosed earlier; such increases were observed among MSM, heterosexuals and IDU. There was no evidence of a change in PI mutation frequency over time.ConclusionOur finding of a recent increase in NRTI and NNRTI mutations is concerning but requires confirmation, ideally in a random sample of specimens from newly diagnosed individuals. Although the actual dates of infection were unknown, the results suggest that drug-resistant strains are commonly circulating within the established HIV epidemics in Ontario.
P3-S4.02 High-risk human papillomavirus (HR-HPV) detection in men with and without the history ofChlamydia trachomatisinfection
Authors: Smelov V , Terekhov V , Ouburg S , Pleijster J , Gorelov A , Novikov A , Morre S 
Published: July 2011

IntroductionHR-HPV andC trachomatis(CT) are among the most often diagnosed viral and bacterial STIs in the world, respectively. It has been speculated that both of them might be involved in urogenital carcinogenesis and, moreover, potentiate each other's impact and acquisition. The evidence points to a possible association between CT infection history and increased acquisition of HR-HPV infection was investigated among 173 urologist's office male attendees.Material and MethodsPenile and urethral swabs, and expressed prostate secret were collected from 173 heterosexual men visiting an urologist's office to get routinely tested for STDs in the year of 2009 in St.PetersburgOnly heterosexual men with no HIV, gonorrhoea, syphilis andT vaginaliswere enrolled in the study. CT infection was detected by in-house RT-PCR assay in St. Petersburg and confirmed in Amsterdam by a molecular test (TaqMan). The presence of HR-HPV DNA in the studied samples was investigated in Amsterdam by the validated worldwide used GP5+/6+ assay.ResultsThe results are presented in the Abstract P3-S4.02 table 1. The overall CT and HPV prevalence in the study group was relatively high: 4.6% and 31.2%, respectively. No significant correlations have been found between HR-HPV findings and CT status (p=1.0).Abstract P3-S4.02 Table 1Detection of HR-HPV infection in 173 men with/without the history ofC trachomatisinfectionCT present, detected during the study (prevalence, %)CT in the past, history of being infected (prevalence, %)CT+CT−CT+CT−CT infection history8 (4.6%)16545 (35.2%)128173 men, in totalHR-HPV infection, detected in2 (25%)53 (32.1%)14 (31.3%)40 (31.3%)ConclusionsOur study demonstrated: (1) CT and HPV prevalence among the Russian population can be high, (2) limited co-infection between HPV and CT infections: HR-HPV types were similarly often detected in both CT+ and CT men, also regardless on their CT acquisition in the past, (3) CT history seems not to increase the HR-HPV acquisition, however, the association between HPV andC trachomatisinfection still remains to be elucidated and follow-up studies especially among women or homosexuals. 4) All samples found RT-PCR CT+ in Russia were confirmed CT+ using molecular biological techniques in Amsterdam, showing the validity of CT detection in some settings in St. Petersburg. At the moment we additionally: (1) extent the study group, (2) investigate low-risk HPV detection and (3) perform immunogenetic analyses.
P3-S4.04 Topical 80% Trichloroacetic Acid (TCA) shows efficacy in the treatment of internal High-Grade Anal Intraepithelial Neoplasia (HGAIN)
Authors: Ho K , Elishaev E , Maciak D , Baker J , Parzynski C , Zhu C , Day R , Cranston R 
Published: July 2011

BackgroundHIV positive men who have sex with men (MSM) are at 60–70 times increased risk of developing anal squamous cell carcinoma than the general population. HGAIN, the putative precursor to cancer, may be ablated by various methods in order to prevent neoplastic progression. While TCA has previously been used clinically to treat keratinised external anal warts, it may also be used to ablate internal HGAIN. Here we report on treatment efficacy and clinical predictors of success.MethodsA retrospective chart review of all patients seen at the Anal Dysplasia Clinic at the Pittsburgh AIDS Center for Treatment was performed between 1 January 2008 and 30 June 2010. 41 HIV positive MSM had biopsy proven HGAIN (AIN1/2, AIN2, AIN 2/3, and AIN3) at high-resolution anoscopy. Treatment involved applying three sequential cotton swabs soaked in 80% TCA to the lesion. Patients were seen at an average of 6 months following treatment for follow-up. Clearance was defined as the absence of HGAIN epithelial markers at HRA (punctuation/mosaicism) or AIN 1/normal epithelium on biopsy. The impact of the following variables on lesion clearance were assessed using univariate logistic regression analysis: age, CD4 count, initial grade of dysplasia on biopsy, concomitant therapy with imiquimod, previous history of HGAIN treatment.ResultsThe mean age of the study population was 52 years and the mean CD4 count was 565 cells/ml. Of the 43 HGAIN lesions treated in 41 patients, 22 (51%) demonstrated clearance of HGAIN epithelial markers. Repeat biopsy was performed on eight lesions and 4 (9%) lesions were AIN1, 3 (7%) lesions were AIN2, and one lesion was ungradable. By univariate logistic regression analysis, patients with a diagnosis of AIN1/2 (compared with those who had AIN2 or greater) demonstrated a non significant trend towards clearance of abnormal visual markers (OR 3.8 p=0.112). All other predictive variables did not achieve statistical significance.ConclusionsOn a per lesion basis, the success of a single visit triple topical application of TCA was 58% that is comparable with previously published treatment studies using techniques such as infrared coagulation. While larger prospective studies are called for, following exclusion of cancer by biopsy, HRA combined with TCA treatment may represent a low-cost, minimally invasive management strategy for this population with a high-incidence of HGAIN.