ORCID Profile
0000-0003-2928-1291
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Monash University
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Monash Health
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Publisher: Elsevier BV
Date: 10-1998
Publisher: Proceedings of the National Academy of Sciences
Date: 23-11-1999
Abstract: In Papua New Guinea (PNG), numerous blood group polymorphisms and hemoglobinopathies characterize the human population. Human genetic polymorphisms of this nature are common in malarious regions, and all four human malaria parasites are holoendemic below 1500 meters in PNG. At this elevation, a prominent condition characterizing Melanesians is α + -thalassemia. Interestingly, recent epidemiological surveys have demonstrated that α + -thalassemia is associated with increased susceptibility to uncomplicated malaria among young children. It is further proposed that α + -thalassemia may facilitate so-called “benign” Plasmodium vivax infection to act later in life as a “natural vaccine” against severe Plasmodium falciparum malaria. Here, in a P. vivax -endemic region of PNG where the resident Abelam-speaking population is characterized by a frequency of α + -thalassemia ≥0.98, we have discovered the mutation responsible for erythrocyte Duffy antigen-negativity (Fy[a−b−]) on the FY*A allele. In this study population there were 23 heterozygous and no homozygous in iduals bearing this new allele (allele frequency, 23/1062 = 0.022). Flow cytometric analysis illustrated a 2-fold difference in erythroid-specific Fy-antigen expression between heterozygous ( FY*A/FY*A null ) and homozygous ( FY*A/FY*A ) in iduals, suggesting a gene-dosage effect. In further comparisons, we observed a higher prevalence of P. vivax infection in FY*A/FY*A (83/508 = 0.163) compared with FY*A/FY*A null (2/23 = 0.087) in iduals (odds ratio = 2.05, 95% confidence interval = 0.47–8.91). Emergence of FY*A null in this population suggests that P. vivax is involved in selection of this erythroid polymorphism. This mutation would ultimately compromise α + -thalassemia/ P. vivax -mediated protection against severe P. falciparum malaria.
Publisher: American Society of Tropical Medicine and Hygiene
Date: 07-10-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2023
Publisher: Informa UK Limited
Date: 06-08-2021
Publisher: American Medical Association (AMA)
Date: 09-08-1999
DOI: 10.1001/ARCHINTE.159.15.1771
Abstract: To ascertain whether prolonged suppression of viral replication can be achieved in clinical practice and to identify factors associated with virological outcome. Retrospective observational study. University-affiliated human immunodeficiency virus (HIV) clinic in Cleveland, Ohio. Patients treated with regimens that included protease inhibitors between June 1995 and December 1997. We identified 366 patients 310 had sufficient virological follow-up data to be included. Virological success was defined as plasma HIV-RNA levels lower than 400 copies/mL at the last clinic visit. Virological failure was sub ided according to the maximum degree of suppression of viral replication achieved. Multivariate analysis was performed to identify baseline factors associated with virological outcome. Virological success was achieved by 47% of patients at a median follow-up of 335 days. The median CD4+ cell count increase and HIV-RNA level decrease were 0.10x10(9)/L (100 cells/microL) and greater than 1.3 log10 in patients who achieved virological success, and 0.010x10(9)/L and 0.32 log10 for those who did not. In multivariate analysis the likelihood of virological success was diminished in women (P<.02) and in patients who missed 2 or more clinic visits in the prior year (P<.001), and decreased when the regimen was started earlier (P<.04). Patients with a lower nadir CD4+ cell count (P<.04) and higher peak plasma HIV-RNA levels (P<.001) also had a decreased likelihood of virological success. More than half the patients who started a regimen that included protease inhibitors in an academic clinical practice failed to achieve durable suppression of viral replication and also experienced a poorer immunologic outcome as determined by CD4+ cell count increase. Missed clinic visits, more advanced disease, and higher plasma HIV-RNA levels may predict failure.
Publisher: Wiley
Date: 02-2012
DOI: 10.1111/J.1445-5994.2011.02616.X
Abstract: We describe three new diagnosis of HIV infection as a direct result of testing following occupational exposures (NSIs) in a low-prevalence setting. In each case the finding was unexpected. Our series provides a reminder of the importance of prompt reporting of NSIs by healthcare workers, access to rapid HIV testing and post-exposure prophylaxis with antiretrovirals to prevent transmission.
Publisher: American Psychiatric Association Publishing
Date: 08-2022
DOI: 10.1176/APPI.PS.202100375
Abstract: Conventional models of health care for the hepatitis C virus (HCV) underserve people with serious mental illness. In a 6-month proof-of-concept study, colocated HCV care coordination was assessed within community mental health settings. The program, which relied on referrals to a visiting hepatologist and was augmented by a part-time nurse practitioner, received 18 referrals for HCV management. From this group, 11 in iduals achieved sustained virological response at 12 weeks after direct-acting antiviral therapy. Seven in iduals declined treatment or were lost to follow-up. Overall, colocated integrated services may play an important role in HCV health care parity for people with serious mental illness.
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14084
Abstract: Background Although it significantly improves HIV-related outcomes, some components of combination antiretroviral therapy (ART) cause lipodystrophy syndrome. The composition of combination ART has changed over time but the impact on lipodystrophy prevalence is unknown. Methods: One hundred HIV-infected males underwent dual-energy X-ray absorptiometry scanning, serum lipid testing and completed a questionnaire in a cross-sectional study in 2010. Thirty-four participants of a 1998 study cohort were re-evaluated in 2010. The same parameters were used to define and compare lipodystrophy, metabolic syndrome and cardiovascular disease (CVD) risk in the two time periods. Results: In 2010, the prevalence of lipodystrophy was lower when compared with 1998 (53% v. 69%, P = 0.012), despite higher mean age (51.8 v. 42.1 years, P 0.0001), duration of HIV (165 v. 86 months, P 0.0001), ART exposure (129 v. 38 months, P 0.0001), CD4+ cell count (601 v. 374 cells µL−1, P 0.0001) and waist circumference (95.5 v. 89.9 cm P 0.0001). Cholesterol (5.0 v. 5.6 mmol L−1, P = 0.0001) and triglycerides (1.9 v. 3.7 mmol L−1, P 0.0001) were significantly lower in 2010. Factors associated with an increased risk of lipodystrophy in 2010 were duration of HIV infection and low-density lipoprotein cholesterol, whereas current tenofovir or abacavir use was associated with a decreased risk of lipodystrophy. On multivariate analysis low-density lipoprotein cholesterol (OR, 2.65 CI, 1.4–4.9) remained significant for an increased risk and current tenofovir or abacavir use with reduced risk of lipodystrophy (OR, 0.096 CI, 0.011–0.83). In 2010 there was a higher prevalence of metabolic syndrome (33 v. 28%) and higher median Framingham CVD risk (9.9% (5.7–14.6) v. 8.2% (4.5–12.9). Conclusion: Despite ageing and longer duration of HIV infection and ART exposure, the prevalence of lipodystrophy in HIV-infected men significantly declined over a 12-year period. However, a trend exists toward a higher prevalence of metabolic syndrome and increased CVD risk.
Publisher: Wiley
Date: 03-2017
DOI: 10.1111/IMJ.13361
Abstract: A cross-sectional survey of 265 adult patients with haematological malignancy, haemoglobinopathy or human immunodeficiency virus was performed to determine the potential risk of infection from animal exposures. One hundred and thirty-seven (52%) owned an animal the majority were dogs (74%) and cats (39%), but 14% owned birds and 3% reptiles. Eighty percent engaged in behaviour with their animals that potentially put them at risk of zoonotic infections. The most frequent behaviours were picking up animal faeces 72 (52%), cleaning animal areas 69 (50%) and allowing animals to sleep in the same bed 51 (37%). Twenty-eight percent allowed the animal to lick their face. Of all patients, 80 (30%) had been bitten or scratched by an animal. Only 16% of those who owned pets could recall receiving education regarding safe behaviours around animals. These immunocompromised patients are at risk of infection through exposure to pets. Our study highlights the need for increased education of patients regarding how to remain safe around their pets.
Publisher: SAGE Publications
Date: 12-2013
Abstract: Anal cancer is relatively common amongst HIV positive men who have sex with men (MSM), but little is known about the anal cancer screening practices of HIV physicians, and whether digital ano-rectal examination (DARE) is utilized for this. To determine the practice of anal cancer screening among HIV physicians, and to identify any barriers for implementing DARE as a method for anal cancer screening. 36 physicians from a sexual health centre, 2 tertiary hospital infectious diseases outpatient clinics, and 2 general practices completed a questionnaire on their practice of anal cancer screening amongst HIV positive MSM. Physicians were asked about their confidence in using DARE for anal cancer screening, and whether they perceived barriers to implementing this in their clinic. Most physicians (86%, 95% CI: 71–95) thought that anal cancer screening was important, but only 22% (95% CI: 10–39) were currently screening. Reasons for not screening were the absence of guidelines (87%, 95% CI: 60–98), lack of time (47%, 95% CI: 30–65), and concern about patient acceptability of DARE (32%, 95% CI: 17–51). Whilst 67% (95% CI: 49–81) of physicians felt confident in performing a DARE, only 22% (95% CI: 10–39) were confident in recognizing anal cancer using DARE. Although HIV physicians were aware of the need for anal cancer screening among the HIV + MSM population, few were routinely screening. If DARE were to be incorporated into routine HIV care, guidelines recommending screening and up-skilling of HIV physicians to recognize anal cancer are needed.
Publisher: Springer Science and Business Media LLC
Date: 18-01-2017
Publisher: Elsevier BV
Date: 02-2021
Publisher: Oxford University Press (OUP)
Date: 11-04-2022
DOI: 10.1093/CID/CIAC277
Publisher: Informa UK Limited
Date: 13-12-2017
DOI: 10.1080/10245332.2017.1414910
Abstract: Asplenia and hyposplenism carry a significant risk of ongoing morbidity and mortality which can be reduced by education, vaccination and antibiotic use. We aimed to assess education and other methods of prevention in a cohort of patients with haemoglobinopathy in a tertiary referral centre, which also had access to a post-splenectomy registry created to reduce post-splenectomy infection risk. A standardized questionnaire was used on patients who attended the service for regular therapy. Patients were also asked about standard post-splenectomy preventive therapies including antibiotics and vaccinations. There were 49 patients who had either had a splenectomy or knew their spleen to be non-functional. Of these, nearly half knew themselves to be on the Victorian Spleen Registry (51.0%). The median knowledge score was 12 (range 4-17) out of a possible 18. Most significantly the benefits of the registry were not seen in terms of knowledge but in delivery of recommended vaccines and the use of a medical alert card. This study examined knowledge and attitudes about splenectomy in a cohort of haemoglobinopathy patients in an Australian tertiary referral centre. The majority had good or fair knowledge with a strong association of some elements of post-splenectomy care with being placed on a spleen registry and having received targeted education. Implementation of systematic approaches by medical staff is likely to be the main benefit of a clinical registry approach in this setting.
Publisher: CSIRO Publishing
Date: 2007
DOI: 10.1071/SH06052
Abstract: Background: There has been increasing concern that HIV-infected in iduals may be more at risk for cardiovascular events in the highly-active antiretroviral therapy (HAART) era. This study examined the risk of thromboembolic events in HIV-infected and non-infected in iduals and the effect of macrolide prophylaxis on those outcomes. Methods: A subcohort analysis was undertaken using data collected in the Multicenter AIDS Cohort Study to examine the relative risk of vascular events (myocardial infarction, unstable angina and ischaemic stroke). Cox proportional hazard model using age as the time scale with time varying cofactors obtained at each semi-annual visit were used to assess the independent effect of macrolide use. Results: Controlling for other significant effects including race and smoking, HIV-infection was not independently associated with vascular events. Increased risk was observed among those who used HAART (relative hazard 1.09, 95% confidence intervals 1.00–1.19 in multivariate model), antihypertensive treatment (1.81 [1.26–2.60]), lipid-lowering medication (1.65 [1.12–2.42]), and antibiotics (1.72 [1.25–2.36]). The protective association of macrolide use for a vascular event in the HAART era was also significant (0.10 [0.01–0.75]). Conclusions: Traditional risk factors are important in the pathogenesis of vascular events in HIV-infected in iduals. Macrolide antibiotics may have a protective effect in the HIV-infected in iduals in the HAART era.
Publisher: Public Library of Science (PLoS)
Date: 07-02-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2004
Publisher: SAGE Publications
Date: 02-2015
DOI: 10.3851/IMP2774
Abstract: There have been improvements in combination antiretroviral therapy (cART) over the past 15 years. The aim of this analysis was to assess whether improvements in ART have resulted in improvements in surrogates of HIV outcome. Patients in the Australian HIV Observational Database who initiated treatment using mono/duo therapy prior to 1996, or using cART from 1996 onwards, were included in the analysis. Patients were stratified by era of ART initiation. Median changes in CD4 + T-cell count and the proportion of patients with detectable HIV viral load ( copies/ml) were calculated over the first 4 years of treatment. Probabilities of treatment switch were estimated using the Kaplan-Meier method. A total of 2,753 patients were included in the analysis: 28% initiated treatment using mono/duo therapy and 72% initiated treatment ≥1996 using cART (30% 1996–1999, 12% 2000–2003, 11% 2004–2007 and 19% ≥2008). Overall CD4 + T-cell count response improved by later era of initiation ( P .001), although 2000–2003 CD4 + T-cell count response was less than that for 1996– 1999 ( P=0.007). The average proportion with detectable viral load from 2 to 4 years post-treatment commencement by era was: mono/duo 0.69 (0.67–0.71), 1996–1999 cART 0.29 (0.28–0.30), 2000–2003 cART 0.22 (0.20–0.24), 2004–2007 cART 0.09 (0.07–0.10) and ≥2008 cART 0.04 (0.03–0.05). Probability of treatment switch at 4 years after initiation decreased from 53% in 1996–1999 to 29% after 2008 ( P .001). Across the five time-periods examined, there have been incremental improvements for patients initiated on cART, as measured by overall response (viral load and CD4 + T-cell count) and also increased durability of first-line ART regimens.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2004
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/SH15210
Abstract: Background: Integrase inhibitors (INSTI) are a newer class of antiretroviral (ARV) drugs that offer additional treatment options for experienced patients. Our aim is to describe treatment durability and virological outcomes in treatment-experienced HIV-positive patients using INSTI-based regimens. Methods: All patients in the Australian HIV Observational Database who had received an INSTI-based regimen ≥ 14 days as well as previous therapy were included in the study. We defined two groups of treatment-experienced patients: (1) those starting a second-line regimen with INSTI and (2) highly experienced patients, defined as having prior exposure to all three main ARV classes, nucleoside reverse transcriptase inhibitor, nonnucleoside reverse transcriptase inhibitors and protease inhibitors, before commencing INSTI. Survival methods were used to determine time to viral suppression and treatment switch, stratified by patient treatment experience. Covariates of interest included age, gender, hepatitis B and C co-infection, previous antiretroviral treatment time, patient treatment experience and baseline viral load. Results: Time to viral suppression and regimen switching from INSTI initiation was similar for second-line and highly experienced patients. The probability of achieving viral suppression at 6 months was 77.7% for second-line patients and 68.4% for highly experienced patients. There were 60 occurrences of regimen switching away from INSTI observed over 1274.0 person-years, a crude rate of 4.71 (95% CI: 3.66–6.07) per 100 person-years. Patient treatment experience was not a significant factor for regimen switch according to multivariate analysis, adjusting for relevant covariates. Conclusions: We found that INSTI-based regimens were potent and durable in experienced HIV-positive patients receiving treatment outside clinical trials. These results confirm that INSTI-based regimens are a robust treatment option.
Publisher: Oxford University Press (OUP)
Date: 15-05-2001
DOI: 10.1086/320164
Abstract: We analyzed the deaths in an outpatient human immunodeficiency virus (HIV) care clinic at University Hospitals in Cleveland from January 1995 through December 1999. The number of annual deaths decreased progressively, from 112 in 1995 to 32 in 1999. The median final CD4(+) cell count before death increased progressively from 10 cells/microL in 1995 to 90 cells/microL in 1999 (P<.01) 20%--25% of patients who died from 1997 through 1999 had plasma HIV RNA levels below detection limits. From 1995 through 1998, deaths due to infection, to end-stage acquired immune deficiency syndrome, and to malignancies decreased, whereas the proportion of deaths due to end-organ failures and of uncertain relationship to HIV infection increased. The spectrum of mortality in HIV disease has changed recently although opportunistic infections cause death less frequently, deaths are occurring in people who have control of HIV replication and with some preservation of immune function. These observations underscore the need to monitor the etiologies of HIV-associated mortality and to better our understanding of the relationships among immune defenses, treatment-related toxicities, and end-organ failure in patients with HIV disease.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2011
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/SH19018
Abstract: Background Gonorrhoea is usually managed in community sexual health or general practice, but a proportion of cases present to hospital settings. In this study, we examined how gonorrhoea was managed through a large hospital network and what the implications may be for public health management. Methods: A retrospective chart review was performed of the management of patients with Neisseria gonorrhoeae infection diagnosed at a large Australian healthcare network from January 2015 to May 2018. Documentation rates of five parameters of care were assessed: (1) the presence (or absence) of previous sexually transmissible infections (STIs) (2) recent travel (3) discussion of HIV testing (4) contact tracing and (5) public health notification. Results: In all, 110 cases (48 male, 62 female) were analysed. Most cases were in the 15–39 years age group 98 cases (89%) were symptomatic, and 12 (11%) were screening tests. The most common presenting syndromes were pelvic inflammatory disease (32% 31/98 symptomatic cases), urethritis (26% 25/98) and epididymo-orchitis (13% 13/98). None of the five parameters assessed were documented in most cases. Documentation was most likely to occur in patients admitted to hospital. When HIV testing was performed, no new cases of HIV were identified. Conclusion: Infections with gonorrhoea present on a regular basis to hospital practice, but overall management is suboptimal. Automated prompts for other recommended tests, including HIV testing when testing for other sexually transmissible diseases is ordered, may improve management. Better awareness of best practice is needed, which can be facilitated with ongoing education. However, the greatest benefit is likely achieved by linking patients back to community-based services, which are best placed to provide ongoing long-term care.
Publisher: Wiley
Date: 05-2005
DOI: 10.1111/J.1468-1293.2005.00280.X
Abstract: To assess the impact of highly active antiretroviral therapy (HAART) on rates of change of antiretroviral treatment among patients co-infected with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) in the Australian HIV Observational Database (AHOD). Analysis was based on 805 of the 2218 patients recruited to the AHOD by March 2003, who had commenced HAART after 1 January 1997, who had recorded test results for HBV surface antigen and anti-HCV antibody, and who had follow-up of more than 3 months. The effect of hepatitis co-infection on the rate of antiretroviral treatment change after commencing HAART was assessed using a random-effect Poisson regression model. Among those included in the analyses, the prevalences of HBV and HCV were 4.8% and 12.8%, respectively. The overall rate of combination antiretroviral treatment change was 0.74 combinations per year. Factors independently associated with an increased rate of change of combination antiretroviral treatment were: prior AIDS-defining illness prior exposure to double combination antiretroviral therapy and antiretroviral treatment class. Co-infection with HBV and/or HCV was not found to be significantly associated with the rate of combination antiretroviral treatment change. While both HBV and HCV co-infections are relatively common in the AHOD, they do not appear to be serious impediments to the treatment of HIV-infected patients.
Publisher: AMPCo
Date: 03-2015
DOI: 10.5694/MJA14.01636
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2010
Publisher: Wiley
Date: 05-2022
DOI: 10.1111/IMJ.15775
Abstract: Australia has approximately 1.6 million Medicare‐ineligible residents, of whom around 450 are living with human immunodeficiency virus (PLHIV). We examined the outcomes in a cohort of 50 Medicare‐ineligible patients presenting to our hospital network over a 15‐year period: 31 women (62%) and 19 men. Twenty‐four were newly diagnosed. Sixteen of 24 remained in Australia more than 1 year after diagnosis. Although the mean CD4 count at initial contact was 353 cells/mm 3 (range 3–2228 standard deviation (SD) = 452.88), 13 people required treatment for opportunistic infections and 21 people required hospital admissions related to HIV, incurring total estimated hospital costs of $886 310. The mean number of contact years spent with the service was 2.2 (range 0–12 SD = 2.6) and 20 people remain under care. Twenty‐seven PLHIV remain in Australia, seven have transferred care within Australia, two people are known to have died and eight are lost to follow up. The median number of admissions was 0 (range 0–4 SD = 1) and median length of admission was 5 days (range 0–73 SD = 19). Many people leave Australia shortly after a diagnosis of HIV, but most Medicare‐ineligible PLHIV remain. Delays in diagnosing HIV and acquiring Medicare status are associated with a significant burden of disease and cost. Keeping people well, on therapy and out of hospital is likely to be cost‐saving in addition to good clinical practice.
Publisher: Wiley
Date: 2005
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2022
Publisher: Oxford University Press (OUP)
Date: 10-01-2019
DOI: 10.1093/QJMED/HCZ016
Publisher: Wiley
Date: 12-2018
DOI: 10.1111/IMJ.14040
Publisher: CSIRO Publishing
Date: 2007
DOI: 10.1071/SH07016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2019
Publisher: Cold Spring Harbor Laboratory
Date: 22-11-2020
DOI: 10.1101/2020.11.19.20235069
Abstract: People with HIV have higher rates of certain comorbidities, particularly cardiovascular disease and some malignancies, than people without HIV. As somatic mutations associated with age-related clonal haematopoiesis (CH) are linked to similar comorbidities in the general population, we hypothesized that CH may be more prevalent in people with HIV. To address this issue, we established a prospective cohort study recruiting 220 HIV-positive and 226 HIV-negative participants aged 55 years or older in Australia. Demographic characteristics, clinical data and peripheral blood were collected to assess for the presence of CH mutations and identify potential risk factors for and clinical sequelae of CH. Investigators testing for CH were blinded to participants’ HIV status. In total, 132 CH mutations were identified in 99 (22.2%) of 446 participants. CH was more prevalent in HIV-positive participants than HIV-negative participants (27.7% vs. 16.8%, p =0.006), overall and across all age groups. HIV infection was associated with an increased odds of having CH (adjusted odds ratio 2.10, 95% confidence interval 1.30-3.38, p=0.002). The most common genes mutated were DNMT3A (48.5%), TET2 (20.5%) and ASXL1 (11.4%). CH and HIV infection were independently associated with increases in blood parameters and biomarkers associated with inflammation. These data suggest a selective advantage for the emergence of CH in the context of chronic infection and inflammation related to HIV infection.
Publisher: Springer Science and Business Media LLC
Date: 30-08-2012
DOI: 10.1007/S15010-011-0181-X
Abstract: The etiology of culture-negative septic arthritis is poorly characterised in persons infected with human immunodeficiency virus (HIV). New molecular methods may assist in the investigation of culture-negative infections of sterile sites, including septic arthritis. We describe the first case of septic arthritis due to the cause of rat bite fever (RBF), Streptobacillus moniliformis, confirmed by 16S rRNA sequence analysis, in a patient with newly diagnosed HIV infection.
Post-splenectomy sepsis: preventative strategies, challenges, and solutions
Publisher: Informa UK Limited
Date: 09-2019
DOI: 10.2147/IDR.S179902
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.JCV.2013.01.008
Abstract: Respiratory infections including influenza are a common cause of acute short-term morbidity in travellers and yet the risk of these infections is poorly defined. To estimate the incidence density of and risk factors for acute respiratory infections (ARIs) and influenza in Australian travellers to Asia. Travel-clinic attendees were prospectively identified and completed questionnaires (demographic data, travel itinerary, health and vaccination history) and also provided pre and post-travel serological s les for Influenza A and B (complement fixation test). Returned travellers with an ARI provided nasopharyngeal specimens for RT-PCR identification of respiratory viruses. In this cohort (n = 387) of predominantly (72%) short-term travellers, 58% were female, the median age was 37 years and 69% were tourists. ARIs occurred in 109 travellers (28%) translating to an incidence of 106.4 ARIs per 10,000 traveller days (95% confidence interval CI 88.6-126.7). The traveller type of missionary or aid worker was a risk factor for acquiring an ARI (p = 0.03) and ARIs occurred early (< 30 days) in the travel period (p = 0.001). Four travellers (1%) acquired influenza A during travel translating to an incidence density of 3.4 infections per 10,000 days of travel (95% CI 1.4-8.6). Influenza vaccination was reported in 49% of travellers with a 3.5-fold higher incidence of influenza in unvaccinated travellers compared to vaccinated travellers (p = 0.883). This is one of the largest prospective studies estimating the incidence of respiratory infections in travellers. These findings have important implications for practitioners advising prospective travellers and for public health authorities.
Publisher: Wiley
Date: 22-02-2017
DOI: 10.1111/HIV.12504
Publisher: Maney Publishing
Date: 03-07-2016
Publisher: Elsevier BV
Date: 04-1999
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-11-2010
Publisher: Mary Ann Liebert Inc
Date: 11-2022
Publisher: Medknow
Date: 12-2017
Publisher: AMPCo
Date: 05-2012
DOI: 10.5694/MJA11.10909
Abstract: To determine the risk and timing of a broad range of infective outcomes and mortality after splenectomy. Analysis of a non-identifiable linked hospital discharge administrative dataset for splenectomy cases between July 1998 and December 2006 in Victoria, Australia. Age, sex, indication for splenectomy, infectious events and death. Patients splenectomised for trauma were compared with patients splenectomised for other indications. Infectious risk was established using Cox proportional hazards models. A total of 2574 patients underwent splenectomy (with 8648 person-years follow-up). Paediatric cases were excluded, leaving 2472 adult cases for analysis. The most common reasons for splenectomy were trauma (635 [25.7%]) and therapeutic haematological indications (583 [23.6%]). After splenectomy, 644 adult patients (26.0%) had a severe infection, with a rate of 8.0 per 100 person-years (95% CI, 7.2-8.4). The risk of severe infection was highest among patients aged > [corrected] 50 years (10.1 [corrected] per 100 person-years 95% CI, 9.3-11.1) [corrected] and those splenectomised for malignancy (14.2 per 100 person-years 95% CI, 11.8-17.1). Gram-negative infections represented the most frequent causative organism group accounting for 698 (51%) of bacterial pathogens. Staphylococcus aureus was the second most common causative organism. The incidence of severe infection and all-cause mortality differed according to age and underlying reason for splenectomy, and was highest among the elderly and those with malignancy, and was lowest among trauma patients. This highlights the need for targeted prevention programs.
Publisher: Research Square Platform LLC
Date: 10-08-2022
DOI: 10.21203/RS.3.RS-1927352/V1
Abstract: Background: There are more than 7,800 people living with human immunodeficiency virus (HIV) in Victoria, Australia. Crucial in maximising the in idual and population level benefits from antiretroviral therapy (ART) is understanding how to achieve patient retention in care and the factors that drive it. This study was an expansion of a 2015 assessment of HIV-care retention in Victoria, which sought out to determine whether the inclusion of a broader range of HIV-healthcare sites would yield more accurate estimates of retention in HIV-care. We aimed to improve our understanding of HIV-care retention in Victoria, Australia, identify people living with HIV (PLHIV) with unknown outcomes, and attempt to re-engage PLHIV in care. Methods: A network of 15 HIV-care sites was established in Victoria, Australia across erse care settings which ranged from low-caseload rural sites to high-caseload metropolitan GP clinics and hospitals. In iduals who had an HIV viral load (VL) performed in both calendar years of 2016 and 2017 were classified as retained in care. In iduals with a VL test in 2016 but not in 2017 were considered to potentially have unknown outcomes as they may have been receiving care elsewhere, have disengaged from care or died. For this group, an intervention of cross-referencing partially de-identified data between healthcare sites, and contact tracing in iduals who still had unknown outcomes was performed. Results : For 5223 in iduals considered to be retained in care across 15 healthcare sites in the study period, 49 had unconfirmed transfers of care to an alternative provider and 79 had unknown outcomes. After the intervention, the number of unconfirmed care transfers was reduced to 17 and unknown outcomes reduced to 51. These changes were largely attributed to people being reclassified as confirmed transfers of care. Retention in care estimates that did not include the patient outcome of confirmed transfer of care ranged from 76.2- 95.8% and did not alter with the intervention. However, retention in care estimates which considered confirmed transfers and those that re-entered care at a new site as retained in care significantly increased across five of the sites with estimates ranging from 80.9- 98.3% pre-intervention to 83.3- 100% post-intervention. In iduals whose outcomes remained unknown post-intervention were more often men who have sex with men (MSM) when compared to other categories (person who injects drugs (PWID), combined PWID/MSM, men who identify as heterosexual or unknown) (74.5% vs 53.5%, [p= 0.06]) and receiving ART at their last HIV-care visit (84.3% vs 67.8% [p= 0.09]). Conclusions: This study confirmed high retention in HIV-care and low numbers of people disengaged from HIV-care in Victoria. This was demonstrated across a larger number of sites with varying models of care than a prior assessment in 2015. These data align with national and state targets aiming for 95% of PLHIV retained in HIV-care.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-08-2018
Publisher: Informa UK Limited
Date: 27-02-2021
Publisher: Wiley
Date: 18-11-2015
DOI: 10.1111/HIV.12188
Publisher: AMPCo
Date: 03-2013
DOI: 10.5694/MJA12.11703
Abstract: To determine research priorities of infectious diseases physicians for clinician-initiated randomised controlled trials (RCTs). Online survey of infectious diseases physicians in Australia and New Zealand. Research priorities for, and perceived barriers to, clinician-initiated RCTs. 122/550 infectious diseases physicians (22%) responded to the survey. The five highest ranked proposals for clinician-initiated RCTs were in the areas of prosthetic joint infections, septic arthritis and osteomyelitis of native joints, Staphylococcus aureus bloodstream infections, diabetic foot infections and the treatment of serious multiresistant, gram-negative bacterial infections. Lack of funding was the most important perceived barrier to participation in clinician-initiated RCTs. The research focus of infectious diseases physicians - optimal treatment of commonly encountered serious infections - highlights a lack of well conducted RCTs in this area.
Publisher: Elsevier BV
Date: 07-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2023
Publisher: Wiley
Date: 13-08-2023
DOI: 10.1111/IMJ.15604
Abstract: People with serious mental illness (SMI) are underserved from a hepatitis C virus (HCV) screening and treatment perspective. To examine the HCV care cascade in people with SMI and to pilot a supported HCV treatment integration programme. HCV prevalence was retrospectively analysed from 4492 consecutive in iduals admitted to a tertiary hospital mental health service between January 2017 and December 2018. Subcohort analysis of screening patterns and predictors of seropositive infection was performed. Referral pathways and community care integration were analysed for HCV‐positive in iduals, and a prospective community‐based ‘identify and treat’ HCV programme was assessed. Screening for HCV had been performed in 18.6% (835/4492) of the cohort. Seroprevalence was 4.6% (207/4492). HCV seropositivity was associated with age years (odds ratio (OR) = 9.30 confidence interval (CI) 3.69–23.45 P 0.01), injecting drug use (OR = 24.26 CI 8.99–65.43 P 0.01) and previous incarceration (OR = 12.26 CI 4.51–33.31 P 0.01). In a cohort of treatment‐eligible in iduals, 43.3% (90/208) had neither been referred to specialist services or general practitioners for HCV management. Amongst those referred to specialist services, 64.7% (57/88) did not attend scheduled follow up, and 48.3% (15/31) of attendees were lost to follow up. Through an intensified community access programme, 10 people were successfully treated for HCV, although 22 could not be engaged. People with SMI are underserved by traditional models of HCV healthcare. Intensified community‐based support can partially bolster the treatment cascade, although investment in innovative screening and management strategies are required to achieve healthcare parity.
Publisher: Wiley
Date: 06-2018
DOI: 10.1111/IMJ.13820
Publisher: American Society of Hematology
Date: 05-03-2015
Publisher: Informa UK Limited
Date: 02-11-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1996
DOI: 10.1097/00002030-199606000-00017
Abstract: Despite the emergence of unique opportunities for social-industrial growth and development resulting from the use of the Internet of Things (IoT), lack of a well-posed IoT governance will cause serious threats on personal privacy, public safety, industrial security, and dubious data gathering by unauthorized entities. Furthermore, adopting a systemic governance approach, particularly for the IoT innovation system, requires a precise clarification on the concept and scope of IoT governance. In this study, by employing the Structural Equation Modeling (SEM) approach, the role of governance in the Iran IoT innovation system is investigated. Contacting respondents across the seven industries, including Information and Communication Technology (ICT), Healthcare, Transportation, Oil and Gas, Energy, Agriculture, and Banking over the course of three months, the authors performed statistical analysis on 319 fulfilled questionnaires using SPPS and Smart PLS software. Findings show that all IoT-related TIS processes have been affected by IoT governance functions. The main result of this study is the proposition of particular governance functions, including policy-making, regulation, facilitation, and service provision with more notable impact on the indicators of the key processes in the IoT-based TIS.
Publisher: Springer Science and Business Media LLC
Date: 17-03-2009
Publisher: Wiley
Date: 05-2008
DOI: 10.1111/J.1445-5994.2007.01579.X
Abstract: Asplenic or hyposplenic patients are at risk of fulminant sepsis. This entity has a mortality of up to 50%. The spectrum of causative organisms is evolving as are recommended preventive strategies, which include education, prophylactic and standby antibiotics, preventive immunizations, optimal antimalarial advice when visiting endemic countries and early management of animal bites. However, there is evidence that adherence to these strategies is poor. Consensus-updated guidelines have been developed to help Australian and New Zealand clinicians and patients in the prevention of sepsis in asplenic and hyposplenic patients.
Publisher: Wiley
Date: 13-07-2018
DOI: 10.1111/HIV.12532
Abstract: The Maraviroc Switch (MARCH) study week 48 data demonstrated that maraviroc, a chemokine receptor-5 (CCR5) inhibitor, was a safe and effective switch for the ritonavir-boosted protease inhibitor (PI/r) component of a two nucleos(t)ide reverse transcriptase inhibitor [N(t)RTI] plus PI/r-based antiretroviral regimen in patients with R5-tropic virus. Here we report the durability of this finding. MARCH, an international, multicentre, randomized, 96-week open-label switch study, enrolled HIV-1-infected adults with R5-tropic virus who were stable (> 24 weeks) and virologically suppressed [plasma viral load (pVL) < 50 HIV-1 RNA copies/mL]. Participants were randomized to continue their current PI/r-based regimen (PI/r) or to switch to MVC plus two N(t)RTIs (MVC) (1:2 randomization). The primary endpoint was the difference in the proportion with pVL < 200 copies/mL at 96 weeks. The switch arm was defined as noninferior if the lower limit of the 95% confidence interval (CI) for the difference was < -12% in the intention-to-treat (ITT) population. Safety endpoints (the difference in the mean change from baseline or a comparison of proportions) were analysed as key secondary endpoints. Eighty-two (PI/r) and 156 (MVC) participants were randomized and included in the ITT analysis 71 (87%) and 130 (83%) were in follow-up and on therapy at week 96. At week 96, 89.0% and 90.4% in the PI/r and MVC arms, respectively, had pVL < 50 copies/mL (95% CI -6.6, 10.2). Moreover, in those switching away from PI/r, there were significant reductions in mean total cholesterol (differences 0.31 mmol/L P = 0.02) and triglycerides (difference 0.44 mmol/L P < 0.001). Changes in CD4 T-cell count, renal function, and serious and nonserious adverse events were similar in the two arms. MVC as a switch for a PI/r is safe and effective at maintaining virological suppression while having significant lipid benefits over 96 weeks.
Publisher: Elsevier BV
Date: 07-2008
Publisher: Oxford University Press (OUP)
Date: 02-2003
DOI: 10.1086/368206
Abstract: To study how GB virus C (GBV-C) coinfection affects the response to highly active antiretroviral therapy (HAART), 146 human immunodeficiency virus (HIV)-infected patients were tested for GBV-C RNA and antibodies against GBV-C E2 protein, and responses to HAART were evaluated. GBV-C-infected patients exhibited a complete virological response to HAART more often than patients without [correction] GBV-C and had a greater increase in median CD4 cell count and a marginally greater median HIV RNA level decrease. This association was found to be independent of baseline CD4 cell count and plasma HIV RNA, which indicates that an association exists between GBV-C infection and response to HAART.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2003
Publisher: Wiley
Date: 08-2000
DOI: 10.1046/J.1537-2995.2000.40080949.X
Abstract: The Duffy (Fy) blood group (also known as Duffy antigen receptor for chemokines, or DARC) may be involved in regulation of the level of circulating proinflammatory chemokines, and it is an obligatory receptor on RBCs for the human malaria parasite Plasmodium vivax. Because quantification of Fy expression by using RBCs of various ages will not detect acute changes associated with inflammatory states, and because P. vivax exclusively invades reticulocytes, a flow cytometric method was developed to measure the level of surface expression of Fy. Reticulocytes and mature RBCs from persons with different genotypes (GATA-1 T-->C promoter mutation at nt -46 FY*A and FY*B in the ORF) were used. Expression of the Fy6 epitope, which is required for P. vivax invasion, was 49 +/- 19 percent higher on reticulocytes than on mature RBCs, regardless of donor genotype (p<0.0001). Fy6 levels were approximately 50 percent lower in persons who were heterozygous for the GATA-1 promoter mutation and were significantly lower on reticulocytes and mature RBCs of the FY*B/FY*B genotype than on those of the FY*A/FY*A or FY*A/FY*B genotype. Fy has greater expression on reticulocytes than on mature RBCs in flow cytometry. This method may be useful in further studies of this antigen, such as characterization of reticulocytes and RBC phenotypes across populations, in response to chemokine regulation, and in the context of susceptibility to P. vivax and other parasites.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-03-2021
Publisher: Oxford University Press (OUP)
Date: 18-11-2019
DOI: 10.1093/OFID/OFZ494
Abstract: Recommended management of Staphylococcus aureus bacteremia (SAB) includes follow up blood culture sets (BCs) to determine the duration of bacteremia. Duration of bacteremia is an important prognostic factor in SAB and follow up BCs have a critical role in differentiation of uncomplicated and complicated SAB. However, intermittent negative BCs occur in SAB. Clinical guidelines for SAB management do not specify an approach to follow up BCs collection or define the number of negative BCs required to demonstrate resolution of bacteremia. This study assessed the frequency of intermittent negative BCs in SAB and used these finding to formulate a recommendation for collection of follow up BCs. This retrospective study reviewed 1071 episodes of SAB. Clinical and microbiological data including the duration of bacteremia and the occurrence of intermittent negative BCs (those preceded and followed by positive cultures) were considered. Intermittent bacteremia occurred in 13% (140/1071) of episodes. A single negative BCs on days 1-3 had a predictive value of 87-93% for resolution of bacteremia although this was improved if all BCs collected within the same day were considered. Intermittent negative BCs are common in SAB. Given this we would not recommend accepting a single negative BCs as demonstrating resolution of the bacteremia. This is particularly important if a patient is to be classified as having an uncomplicated SAB.
Publisher: SAGE Publications
Date: 20-04-2011
Abstract: The significance of interethnic variation in CD4 counts between Asian and Caucasian populations is not known. Patients on combination antiretroviral therapy from Treat Asia and Australian HIV Observational Databases (TAHOD, predominantly Asian, n = 3356 and AHOD, predominantly Caucasian, n = 2312, respectively) were followed for 23 144 person-years for AIDS/death and all-cause mortality endpoints. We calculated incidence-rates and used adjusted Cox regression to test for the interaction between cohort (TAHOD/AHOD) and time-updated CD4 count category (lagged by 3 months) for each of the endpoints. There were 382 AIDS/death events in TAHOD (rate: 4.06, 95%CI: 3.68-4.50) and 305 in AHOD (rate: 2.39, 95%CI: 2.13-2.67), per 100 person-years. At any given CD4 count category, the incidence-rates of endpoints were found to be similar between TAHOD and AHOD (in the adjusted models, P .05 for the interaction term between cohort type and latest CD4 counts). At any given CD4 count, risk of AIDS or death was not found to vary by ethnicity, suggesting that the CD4 count thresholds for predicting outcomes defined in Caucasian populations may be equally valid in Asian populations.
Publisher: AMPCo
Date: 08-2015
DOI: 10.5694/MJA15.00334
Publisher: American Society of Hematology
Date: 15-06-2023
DOI: 10.1182/BLOODADVANCES.2022008221
Abstract: Venetoclax is an effective treatment for certain blood cancers, such as chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML). However, most patients relapse while on venetoclax and further treatment options are limited. Combining venetoclax with immunotherapies is an attractive approach however, a detailed understanding of how venetoclax treatment impacts normal immune cells in patients is lacking. In this study, we performed deep profiling of peripheral blood (PB) cells from patients with CLL and AML before and after short-term treatment with venetoclax using mass cytometry (cytometry by time of flight) and found no impact on the concentrations of key T-cell subsets or their expression of checkpoint molecules. We also analyzed PB from patients with breast cancer receiving venetoclax long-term using a single-cell multiomics approach (cellular indexing of transcriptomes and epitopes by sequencing) and functional assays. We found significant depletion of B-cell populations with low expression of MCL-1 relative to other immune cells, attended by extensive transcriptomic changes. By contrast, there was less impact on circulating T cells and natural killer (NK) cells, with no changes in their subset composition, transcriptome, or function following venetoclax treatment. Our data indicate that venetoclax has minimal impact on circulating T or NK cells, supporting the rationale of combining this BH3 mimetic drug with cancer immunotherapies for more durable antitumor responses.
Publisher: Wiley
Date: 05-2020
DOI: 10.1111/IMJ.14621
Abstract: In iduals splenectomised for trauma have lower infection rates than those splenectomised for other conditions. Residual functional splenic tissue (FST) after splenectomy may provide ongoing immunological protection. To quantify the prevalence and volume of residual FST post-splenectomy using standard testing. Splenectomised adults were recruited from the Spleen Australia clinical registry. Eligible in iduals had been splenectomised at least 1 year prior to their visit and resided in Victoria. Splenic function was identified by evaluating Howell-Jolly bodies and IgM memory B cells. A 99m-Technetium-labelled, heat-denatured erythrocyte scintigraphic scan was performed if splenic function was detected. Initially, 75 splenectomised in iduals (all cause) were recruited, with a median of 58 years of age and who were splenectomised a median of 14 years previously. The most common indications for splenectomy were trauma (30.7%) and haematological disease (28.0%). Scintigraphy identified FST in nine in iduals (12.0%). Eight had been splenectomised for trauma. In this cohort, 34.8% of in iduals splenectomised for trauma had residual FST. To explore our findings further, 45 additional in iduals were recruited, predominately in iduals splenectomised for trauma. Twenty-five in iduals completed assessments by December 2018. An additional 11 in iduals had FST, of whom 9 had been splenectomised for trauma. Overall, we identified 20 in iduals with residual FST. Volumes ranged from 2.2 to 216.0 cc. We saw in iduals with accessory spleens and splenotic nodules and an in idual with both. Seventeen in iduals had been splenectomised for trauma. Residual FST is commonly seen in in iduals splenectomised for trauma. It can present in varying distributions and of varying volume. The clinical significance is unclear.
Publisher: Wiley
Date: 07-2019
DOI: 10.1002/JIA2.25331
Publisher: Wiley
Date: 06-2020
DOI: 10.1111/IMJ.14866
Publisher: Oxford University Press (OUP)
Date: 05-10-2019
DOI: 10.1093/QJMED/HCY223
Abstract: To evaluate prior prevalence of HIV indicator conditions in late-presenters with HIV infection. Retrospective cohort study between 2000 and 2014 in a healthcare network in Melbourne, Australia comparing patients presenting with late diagnosis of HIV infection (CD4 < 350 cells/ml) to those patients who had a CD greater than or equal to 350 cells/ml at presentation. The European AIDS Clinical Society guidelines on HIV indicator guided testing were used to assess for any indicator conditions in their prior medical history which may have represented a missed opportunity for earlier diagnosis. Main outcome measures: Descriptive statistics and prevalence of HIV indicator conditions. Of 436 patients with HIV infection, 82 were late presenters. Late presenters were more commonly male (83% vs. 75%, P = 0.11), older (mean age 45 vs. 39 years), born overseas (61% vs. 58%, P = 0.68) and report heterosexual transmission as their exposure risk (51% vs. 31%, P < 0.001). Of 80 patients with late presentation of HIV infection, 54 (55%) had at least one, 29 (36%) at least 2, 12 (15%) at least 3 and 5 (6%) had 4 or more previous HIV indicator conditions which would have triggered HIV testing according to guidelines. The most common indicator conditions were: unexplained loss of weight (31%), herpes zoster (10%), thrombocytopenia or leukopenia (10%), oral or oesophageal candidiasis (10%) and community acquired pneumonia (9%). Twenty patients (25%) had HIV indicator conditions diagnosed at least 12 months before the eventual diagnosis of HIV infection. Patients diagnosed with late-presenting HIV often had an HIV indicator condition prior to presentation, presenting a missed opportunity for earlier diagnosis.
Publisher: Wiley
Date: 30-08-2013
Publisher: SAGE Publications
Date: 02-2015
DOI: 10.3851/IMP2822
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2021
Publisher: Wiley
Date: 21-06-2018
DOI: 10.1111/HIV.12637
Abstract: As treatment improves, people living with HIV (PLWHIV) can now expect to live longer, which means that the foci of HIV-related care for them and their medical practitioners continue to change. With an increasingly older cohort of patients with HIV infection, practitioners' key considerations are shifting from issues of acute treatment and patient survival to multiple comorbidities, toxicities associated with chronic therapy, and ongoing health maintenance. Within this context, this paper explores the current standard of practice for the management of HIV infection in Australia. We surveyed 56 Australian practitioners currently involved in managing HIV infection: 'HIV section 100' (HIV therapy-prescribing) general practitioners (s100 GPs n = 26), sexual health physicians (SHPs n = 24) and hospital-based physicians (HBPs n = 6). Survey results for practice approaches and challenges were broadly consistent across the three practitioner specialties, apart from a few key areas. s100 GPs reported less prophylaxis use among patients whom they deemed at risk of HIV infection in comparison with SHPs, which may reflect differences in patient populations. Further, a higher proportion of s100 GPs nominated older HIV treatment regimens as their preferred therapy choices compared with the other specialties. In contrast with SHPs, s100 GPs were less likely to switch HIV therapies to simplify the treatment protocol, and to immediately initiate treatment upon patient request in those newly diagnosed with HIV infection. Considerably lower levels of satisfaction with current HIV practice guidelines were also reported by s100 GPs. It appears that greater support for s100 GPs may be needed to address these identified challenges and enhance approaches to HIV practice. Across all specialties, increasing access to mental health services for patients with HIV infection was reported as a key management issue. A renewed focus on providing improved mental health and wellbeing supports is recommended, particularly in the face of an ageing HIV-infected population.
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/SH08048
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2018
Publisher: Wiley
Date: 2011
Publisher: Microbiology Society
Date: 08-2015
Publisher: Wiley
Date: 03-06-2022
DOI: 10.1111/IMJ.15397
Abstract: People who inject drugs (PWID) are known to be at increased risk of infectious diseases including bacterial and blood-borne viral infections. However, there is limited literature surrounding the burden of spinal infections as a complication of injecting drug use (IDU). To quantify the clinical and financial burden of IDU-related spinal infections. Retrospective chart review of adult PWID with spinal infections requiring hospital admission to a tertiary health service in Melbourne, Australia between 2011 and 2019. Fifty-seven PWID with 63 episodes of spinal infections were identified with a median hospital stay of 47 days (interquartile range (IQR) 16 range 4-243 days). One-third of episodes required neurosurgical intervention and 11 (17%) episodes required intensive care unit admission (range 2-17 days). Staphylococcus aureus was the most common causative pathogen, present in three-quarters of all episodes (n = 47). The median duration of antibiotic regime was 59 days (IQR 42) and longer courses were associated with known bacteraemia (P = 0.048), polymicrobial infections (P = 0.001) and active IDU (P = 0.066). Predictors of surgery include neurological symptoms at presentation (relative risk (RR) 2.6 P = 0.010), inactive IDU status (RR 3.0 P = 0.002), a diagnosis of epidural abscess (RR 4.1 P = 0.001) and spinal abscess (RR ∞ P < 0.001). Completion of planned antimicrobial therapy was reported in 51 (82%) episodes. Average expenditure per episode was A$61 577. Spinal infections in PWID are an underreported serious medical complication of IDU. Although mortality is low, there is significant morbidity with prolonged admissions, large antimicrobial requirements and surgical interventions generating a substantial cost to the health system.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-08-2013
Abstract: HIV infection leads to activation of coagulation, which may increase the risk for atherosclerosis and venous thromboembolic disease. We hypothesized that HIV replication increases coagulation potentially through alterations in extrinsic pathway factors. Extrinsic pathway factors were measured among a subset of HIV participants from the Strategies for Management of Anti‐Retroviral Therapy ( SMART ) trial. Thrombin generation was estimated using validated computational modeling based on factor composition. We characterized the effect of antiretroviral therapy ( ART ) treatment versus the untreated state ( HIV replication) via 3 separate analyses: (1) a cross‐sectional comparison of those on and off ART (n=717) (2) a randomized comparison of deferring versus starting ART (n=217) and (3) a randomized comparison of stopping versus continuing ART (n=500). Compared with viral suppression, HIV replication consistently showed short‐term increases in some procoagulants (eg, 15% to 23% higher FVIII P .001) and decreases in key anticoagulants (eg, 5% to 9% lower antithrombin [ AT ] and 6% to 10% lower protein C P .01). The net effect of HIV replication was to increase coagulation potential (eg, 24% to 48% greater thrombin generation from computational models P .01 for all). The pattern of changes from HIV replication was reversed with ART treatment and consistent across all 3 independent comparisons. HIV replication leads to complex changes in extrinsic pathway factors, with the net effect of increasing coagulation potential to a degree that may be clinically relevant. The key influence of changes in FVIII and AT suggests that HIV ‐related coagulation abnormalities may involve changes in hepatocyte function in the context of systemic inflammation. URL: ClinicalTrials.gov . Unique identifier: NCT 00027352.
Publisher: SAGE Publications
Date: 07-2004
DOI: 10.1177/154510970400300303
Abstract: HIV infection, AIDS, and antiretroviral therapy (ART) have been associated with bone fragility fractures, although the prevalence and incidence are not well studied by researchers. In HIV and ART, osteopenia and osteoporosis are multifactorial, and health promotion or medical health maintenance should anticipate and prevent morbidity of bone fragility fractures.
Publisher: Wiley
Date: 2019
DOI: 10.1002/JIA2.25219
Publisher: Wiley
Date: 26-01-2014
DOI: 10.1111/HIV.12124
Publisher: SAGE Publications
Date: 25-07-2013
Abstract: Vasculitis has long been associated with chronic viral infections, thus the twin perils of the infection and the immune response against it that bedevils the specialties of infection and immunity. After HIV was identified, it too became associated with vasculitic syndromes. Later, hepatitis C virus was also isolated, identified and described with its own spectrum of vasculitic diseases, including hepatitis C virus-associated cryoglobulinaemia. With the increasing prevalence of HIV and hepatitis C virus coinfection, there has come an increasing recognition of the range of vasculitides that can occur in this population leading to significant morbidity, diagnostic and treatment challenges. In this review, we examine the epidemiology, pathogenesis and general principles of treatment of these systemic diseases in HIV/hepatitis C virus coinfected in iduals.
Publisher: Springer Science and Business Media LLC
Date: 06-2021
Publisher: IEEE
Date: 2005
Publisher: Elsevier BV
Date: 03-2023
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/J.METABOL.2005.07.012
Abstract: HIV infection is commonly associated with hypoalphalipoproteinemia. It is not clear how much the HIV infection and/or treatment contribute to the changes in high-density lipoprotein (HDL) levels. Blood lipids of HIV-positive males were assessed in a retrospective study. The following groups of patients were studied: (1) untreated for at least 6 months (2) treatment with highly active antiretroviral therapy (HAART) without protease inhibitor (PI) (3) treatment with a HAART regimen that includes a PI (HAART/PI) (4) treatment with HAART that includes low-dose ritonavir and a PI (HAART/PI/boost). Lipoprotein levels were compared with those of age-matched HIV-negative healthy subjects. Compared with the control group, HDL-cholesterol (HDL-C) levels were 22%, 11%, 14%, and 11% lower for currently untreated HIV, HAART, HAART/PI, and HAART/PI/boost groups, respectively. Negative correlations were found among HDL-C level, peak and current viral load, and duration of the disease and the treatment. A positive correlation was found between HDL-C and current and nadir CD4 cell count and CD4 percentage. When patients were ided into subgroups based on duration of antiretroviral therapy, patients treated with HAART and HAART/PI for 3 to 6 years were significantly less likely to have high HDL-C levels compared with the control group and patients treated for 1 to 3 years. A 5-fold decrease in the proportion of subjects with high HDL-C and a 3-fold increase in those with low HDL-C were found in the group treated with HAART/PI/boost. These data suggest that hypoalphalipoproteinemia in patients with HIV is likely to be secondary to HIV infection itself.
Publisher: SAGE Publications
Date: 19-06-2007
Abstract: Background: Statins are increasingly used in HIV-infected patients, but the effect of their immunomodulatory properties on antiretroviral-induced immune reconstitution is unknown. Methods: The authors compared 6-month and 1-year changes in CD4 T-cell count, plasma HIV ribonucleic acid (RNA), and serum lipids in 69 HIV-infected patients receiving statins and 127 controls matched by age, nadir CD4 T-cell count, and hepatitis C serostatus. All patients were receiving highly active antiretroviral therapy (HAART). The authors used standard statistical tests for univariate comparisons and estimated average change in outcome measurements through repeated measures general linear models. Results: Patients receiving statins had significantly higher median CD4 T-cell counts (430 vs 225 cells/µL, P .001) and lower HIV RNA levels (2.3 vs 2.9 log10 copies/mL, P .001) than controls. Statin-treated patients had diminished CD4 T-cell gain at 6 months, but this difference was not statistically significant at 12 months, despite similar 12-month virologic success rates. Patients receiving statins gained, on average, an estimated 60 fewer CD4 T-cells in the first 6 months than controls. Conclusions: Exposure to statins was associated with decreased CD4 T-cell gains during HAART in a cohort of HIV-infected patients, despite adequate virologic response. Studies with longer follow-up and detailed metabolic and immunologic monitoring are needed to confirm these findings and assess their significance and mechanisms.
Publisher: Springer Science and Business Media LLC
Date: 17-01-2019
DOI: 10.1007/S11096-018-00781-4
Abstract: Background In Australia, it is not known how much antibiotic prescribing by infectious diseases physicians is long-term, or how confident they are with the evidence behind this practice. Objective Survey Australian infectious diseases physicians to assess attitudes and prescribing practice prescribing prolonged courses of antibiotics. Methods An online questionnaire was distributed to the mailing group for the Australian Society of Infectious Diseases. Responses were collected from 29th October to 12th November 2015. Results The majority of respondents practiced in Australia as Infectious Diseases physicians, microbiologists, or trainees. 88% had prescribed long-term antibiotics. Heterogeneity was noted in the indications for prescription, including recurrent UTIs, cellulitis or chest infections, prosthetic joint infection and vascular graft infection. Beta-lactams antibiotics were prescribed most frequently. 22% of respondents had prescribed rif icin/fusidic acid most frequently, while 11% could not identify a single antibiotic that they used most frequently, due to the heterogeneity of indications for prescribing. 95% stated that they would stop long-term antibiotic therapy if appropriate, and 74% were willing to enrol their patients into a randomised control trial looking at stopping long-term therapy. Conclusion Most infectious diseases physicians who responded to the survey prescribe long-term antibiotics, with great heterogeneity in the indications for which these antibiotics are prescribed.
Publisher: Wiley
Date: 06-2015
DOI: 10.1111/IMJ.12753
Abstract: Our primary aim was to determine the rate of overseas travel in immunocompromised in iduals attending appropriate clinics at an Australian tertiary care hospital. We also aimed to characterise health-seeking behaviour prior to travel and investigated sources of pre-travel advice, compared travel patterns and activities between three specific immunosuppressed groups, and examined pre-immunosuppression patient serology. We implemented a cross-sectional survey of patients between February and August 2012. This survey was implemented among three outpatient populations at Monash Medical Centre, an Australian tertiary care hospital. We recruited 254 immunosuppressed adults from three patient populations: human immunodeficiency virus-positive in iduals, renal transplant patients and rheumatology patients requiring immunosuppressive therapy. No clinical intervention was performed. In the 10 years preceding the survey, 153 (60.2%) participants reported international travel. Of these, 105 (68.6%) were immunosuppressed at the time of travel. These patients were 47.6% male and 60% Australian born. Forty per cent were visiting friends and relatives as part of their travel. Fifty-four per cent of those immunocompromised at the time of travel were going to high-risk destinations. Pathology files indicated that serological screening was frequently not performed prior to immunosuppression in the renal transplant and rheumatology groups. Immunocompromised patients often travel to high-risk destinations with limited or inadequate pre-travel preparations. Doctors caring for the immunocompromised should be aware of travel risks, suitable vaccination protocols and when to refer to specialist travel clinics.
Publisher: Oxford University Press (OUP)
Date: 05-2013
DOI: 10.1111/JTM.12019
Abstract: The risk of Japanese encephalitis (JE) in travelers is unknown. In this prospective study, we investigated the incidence of JE in 387 short-term Australian travelers visiting Asia over a 32-month period from August 2007 to February 2010 by performing pre- and post-travel antibody testing. No travelers were infected with JE virus during travel, indicating a low risk of infection for short-term travelers.
Publisher: Wiley
Date: 26-06-2006
DOI: 10.1111/J.1445-2197.2006.03775.X
Abstract: Vaccination, education and use of long-term antibiotics are recommended in expert guidelines for the prevention of infectious complications after splenectomy. However, studies outside Australia have shown poor adherence to the guidelines. The aim of this study was to determine overall adherence to the guidelines and to ascertain any independent risk factors for poor compliance with the guidelines. A retrospective review of hospital records between 1999 and 2004 was carried out. Indications for splenectomy of the 111 patients in this review included post-trauma (32), haematological (32), cancer surgery (24), iatrogenic (12) and others (11). On multivariable analysis, age was associated with a 28% less likelihood to receive education (odds ratio (OR) 0.72 95% confidence interval (CI) 0.56-0.92 P = 0.009) and 36% less likelihood to receive long-term antibiotics (OR 0.64 95% CI 0.52-0.80 P < or = 0.001). Women were four times more likely to receive education (OR 4.03 95% CI 1.16-14.0 P = 0.028) and patients who had undergone splenectomy in 2004 were 22 times more likely to have received education compared with those in 1999 (OR 22.53 95% CI 3.12-162.34 P = 0.002). Education for prevention of sepsis after splenectomy is poorly documented and may be incomplete. Older age and male sex are risk factors in non-adherence to guidelines for prevention of postsplenectomy sepsis. Strategies such as alert cards and information brochures may improve adherence to guidelines particularly in older patients.
Publisher: Oxford University Press (OUP)
Date: 11-1997
DOI: 10.1086/516961
Publisher: American Thoracic Society
Date: 05-2012
DOI: 10.1164/AJRCCM-CONFERENCE.2012.185.1_MEETINGABSTRACTS.A4568
Publisher: Springer Science and Business Media LLC
Date: 21-10-2016
DOI: 10.1007/S10096-015-2505-8
Abstract: Healthcare-associated Staphylococcus aureus bacteremia (HA-SAB) is an increasingly frequently observed complication of medical treatment. Current guidelines recommend evaluation with echocardiography and preferably transesophageal echocardiography for the exclusion of infectious endocarditis (IE). We performed a retrospective analysis of all patients with HA-SAB between 1 January 2007 and 31 July 2012. Patients were ided into those with a high degree of clinical suspicion of IE (prosthetic intracardiac device, hemodialysis or positive blood cultures for 4 days or more) or those with a low degree of clinical suspicion of IE (absence of high-risk features based on previous literature as strong indicators of endocarditis). Three hundred and fifty-eight patients with HA-SAB were evaluated to determine the prevalence of IE, including 298 (83 %) who had echocardiography. Fourteen patients (4 %) had a final diagnosis of IE after echocardiography. In the group with a high degree of clinical suspicion 11 out of 84 patients (13 %) had IE. In the group with a low degree of clinical suspicion group 3 out 274 patients (1.1 %) had IE. HA-SAB has a low rate of IE, especially in the absence of high-risk features such as prolonged bacteremia, intracardiac prosthetic devices, and hemodialysis. Echocardiographic imaging in this low-risk population of patients is rarely helpful and may generally be avoided, although careful clinical follow-up is warranted. Patients with HA-SAB who have mechanical valves, intracardiac devices, prolonged bacteremia or dialysis dependency have a high incidence of IE and should be evaluated thoroughly using echocardiography.
Publisher: Oxford University Press (OUP)
Date: 27-06-2011
DOI: 10.1093/JAC/DKR249
Publisher: SAGE Publications
Date: 10-01-2015
Abstract: We report a case of disseminated Mycobacterium haemophilum osteomyelitis in a patient with advanced HIV infection, who later developed recurrent immune reconstitution inflammatory syndrome after commencement of antiretroviral therapy. We review previous reports of M. haemophilum bone and joint infection associated with HIV infection and describe the management of M. haemophilum-associated immune reconstitution inflammatory syndrome, including the role of surgery as an adjunctive treatment modality and the potential drug interactions between antiretroviral and antimycobacterial agents.
Publisher: Bentham Science Publishers Ltd.
Date: 11-2012
DOI: 10.2174/187152612804142189
Abstract: Scientific drug design enables the production of novel agents that may be specific for in idual malaria species, particularly by targeting their methods of cellular entry. Though there are practical and theoretical barriers to introducing novel agents into clinical practice, there may also be theoretical benefits to encourage further investigation of such agents, including a reduction in the rate of development of falciparum resistance. This paper discusses the potential risks and benefits such agents using the ex le of CCR5 blockers, drugs which are already in use for HIV treatment, but may be able to block DARC, the site of Plasmodium vivax into the human red blood cell.
Publisher: Elsevier BV
Date: 09-2004
Publisher: Wiley
Date: 04-02-2020
DOI: 10.1111/HIV.12833
Publisher: Springer Science and Business Media LLC
Date: 22-04-2022
DOI: 10.1007/S00277-022-04765-3
Abstract: Congenital asplenia is a rare disorder commonly associated with other visceral and cardiac congenital anomalies. Isolated congenital asplenia is even less common than syndromic forms. The risk of severe bacterial infections associated with asplenia is the most concerning clinical implication and carries a significant mortality risk. Prophylactic measures against the clinical syndrome known as overwhelming postsplenectomy infections (OPSI) include vaccination, prophylactic and emergency antibiotics and health education including fever management and travel advice. This case series describes fourteen adults with congenital asplenia and polysplenia syndrome, most of whom were diagnosed incidentally as adults, and outlines the nature of their diagnosis, clinical phenotype, family history and key pathology findings.
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/SH10008
Abstract: Background Patients who have become triple class experienced (TCE) are at a high risk of exhausting available treatment options. This study aims to investigate factors associated with becoming TCE and to explore the effect of becoming TCE on survival. We also project the prevalence of TCE in Australia to 2012. Methods: Patients were defined as TCE when they stopped a combination antiretroviral treatment (cART) that introduced the third of the three major antiretroviral classes. Cox proportional hazards models were used to investigate factors associated with TCE and the effect of TCE on survival. To project TCE prevalence, we used predicted rates of TCE by fitting a Poisson regression model, together with the estimated number of patients who started cART in each year in Australia, assuming a mortality rate of 1.5 per 100 person-years. Results: Of the 1498 eligible patients, 526 became TCE. Independent predictors of a higher risk of TCE included current CD4 counts below 200 cells μL–1 and earlier calendar periods. No significant difference in survival was observed between those who were TCE and those who were not yet TCE. An increasing number of patients are using cART in Australia and if current trends continue, the number of patients who are TCE is estimated to increase from 2800 in 2003 to 5000 in 2012. Conclusion: Our results suggest that the prevalence of TCE in Australia is estimated to plateau after 2003. However, as an increasing number of patients are becoming TCE, it is necessary to develop new drugs that come from new classes or do not have overlapping resistance.
Publisher: SAGE Publications
Date: 26-01-2021
Publisher: Elsevier BV
Date: 02-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-03-2011
Publisher: Wiley
Date: 29-07-2018
DOI: 10.1111/NEP.13100
Publisher: Wiley
Date: 03-2020
DOI: 10.1111/IMJ.14641
Abstract: Australian National human immunodeficiency virus (HIV) Testing policy recommends HIV indicator condition-based testing, adapted from the European AIDS Clinical Society (EACS) guidelines. To evaluate the extent that Australian non-HIV specialty guidelines mention and recommend HIV testing in HIV indicator conditions. EACS guidelines were reviewed to produce a list of 24 AIDS-defining conditions (ADC) and 31 indicator conditions (IC) where HIV prevalence >0.1%, and 5 IC where HIV non-diagnosis would have adverse effect on patients' management. Australian guidelines for these conditions were identified from websites of specialty societies, electronic Therapeutic Guidelines, National Health and Medical Research Council (NHMRC), state governments, MEDLINE and Google searches. We identified eight key IC as that were part of the HIDES I study. Overall, 51 ADC and IC had Australian guidelines: 24/51(47%) mention association with HIV and 14/51 (27%) recommend HIV testing. Twenty-five out of 51 (49%) Australian guidelines were for ADC: 18/25(72%) mention association with HIV and 5/25 (20%) recommend testing. Twenty-five out of 51 (49%) were guidelines IC with HIV prevalence of 0.1%: 6/25 (24%) mention HIV association and 8/25 (32%) recommend HIV testing. Two of eight (25%) key IC had no Australian guidelines and 3/8 (38%) do not mention HIV association or recommend HIV testing. Although almost half of HIV non-HIV guidelines for ADC and IC mention HIV association, only 27% specifically recommend HIV testing. This suggests partnership with guideline development and specialist groups may be useful to ensure patients diagnosed with ADC/IC are tested for HIV.
Publisher: BMJ
Date: 06-2022
DOI: 10.1136/BMJOPEN-2021-059309
Abstract: To provide estimates for how different treatment pathways for the management of severe aortic stenosis (AS) may affect National Health Service (NHS) England waiting list duration and associated mortality. We constructed a mathematical model of the excess waiting list and found the closed-form analytic solution to that model. From published data, we calculated estimates for how the strategies listed under Interventions may affect the time to clear the backlog of patients waiting for treatment and the associated waiting list mortality. The NHS in England. Estimated patients with AS in England. (1) Increasing the capacity for the treatment of severe AS, (2) converting proportions of cases from surgery to transcatheter aortic valve implantation and (3) a combination of these two. In a capacitated system, clearing the backlog by returning to pre-COVID-19 capacity is not possible. A conversion rate of 50% would clear the backlog within 666 (533–848) days with 1419 (597–2189) deaths while waiting during this time. A 20% capacity increase would require 535 (434–666) days, with an associated mortality of 1172 (466–1859). A combination of converting 40% cases and increasing capacity by 20% would clear the backlog within a year (343 (281–410) days) with 784 (292–1324) deaths while awaiting treatment. A strategy change to the management of severe AS is required to reduce the NHS backlog and waiting list deaths during the post-COVID-19 ‘recovery’ period. However, plausible adaptations will still incur a substantial wait to treatment and many hundreds dying while waiting.
Publisher: Wiley
Date: 11-2004
Publisher: Wiley
Date: 05-2010
Publisher: Oxford University Press (OUP)
Date: 04-06-2018
DOI: 10.1093/JAC/DKY174
Abstract: The decision to prescribe long-term or 'life-long' antibiotics in patients requires careful consideration by the treating clinician. While several guidelines exist to help assist in this decision, the long-term consequences are yet to be well studied. In this review, we aim to provide a summary of the available evidence for patient populations where long-term antibiotic therapy is currently recommended in clinical practice. We will also discuss the pitfalls of this approach, including medication adverse effects, economic cost and any possible contribution to the emerging epidemic of microbial resistance.
Publisher: CSIRO Publishing
Date: 2017
DOI: 10.1071/SH17045
Abstract: Previously we found that local patients were often not tested for HIV prior to commencing nucleoside/nucleotide reverse transcription inhibitor (NRTI) therapy for hepatitis B virus. We performed a national cross-sectional cohort study of physician practices via an online survey. A small majority (23/44 52%) of participants reported always testing their hepatitis B virus patients for HIV prior to NRTI therapy, and 8/44 (18%) reported testing for HIV the majority of the time. Thirteen (30%) respondents reported testing only if risk factors were present. One physician reported a patient seroconverting to HIV while on TDF monotherapy.
Publisher: Springer Science and Business Media LLC
Date: 10-11-2006
DOI: 10.1007/S10096-006-0224-X
Abstract: Rat-bite fever is a rare zoonotic infection caused by Streptobacillus moniliformis or Spirillum minus, which is characterised by fever, rash and arthritis. The arthritis has previously been described as non-suppurative and isolation of the organism from synovial fluid as very uncommon. This article reports a case of septic arthritis diagnosed as rat-bite fever when the organism was cultured from synovial fluid and reviews another 15 cases of S. moniliformis septic arthritis reported in the worldwide literature since 1985. Articles were included in this review if S. moniliformis was cultured from synovial fluid. Of the published cases, 88% presented with polyarthritis, affecting small and large joints although two had monoarticular hip sepsis. Fever was present in 88%, rash in 25% and 56% had extra-articular features. Synovial fluid analysis revealed high cell counts in all cases (mean 51,000 x 10(9)/l) with a predominance of polymorphonuclear leucocytes, and organisms were found on Gram stain in only 50%. Penicillin was used for treatment in 56% of cases and surgery was required in 30%. All patients recovered. Rat-bite fever arthritis can be suppurative and attempts should be made to isolate the organism from synovial fluid. The diagnosis should be considered when there is arthritis and a high synovial fluid cell count but no apparent organism, especially when the patient has had contact with rats.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2016
Publisher: Wiley
Date: 10-1997
Publisher: Wiley
Date: 2015
Publisher: Public Library of Science (PLoS)
Date: 15-06-2012
Publisher: Mary Ann Liebert Inc
Date: 12-2013
Publisher: CSIRO Publishing
Date: 2006
DOI: 10.1071/SH06001
Abstract: Background: Hypertriglyceridaemia is a recognised metabolic abnormality in HIV-infected people, increasing in severity in people treated with highly active antiretroviral therapy (HAART). An alternative treatment for hypertriglyceridaemia in non-HIV-infected populations is omega-3 fatty acid supplementation. This study aimed to compare the effectiveness of omega-3 fatty acid supplementation and placebo in lowering fasting triglyceride levels in HIV-infected patients on HAART. Methods: A placebo-controlled, randomised, double-blind trial in participants on stable HAART with fasting triglycerides of .5 mm to 10.0 mm using 9 g of omega-3 fatty acids versus placebo (olive oil) after a 6-week lead in on dietary therapy. Results: Eleven patients were enrolled. The mean triglyceride level for the population decreased from 5.02 mm at baseline to 4.44 mm (–11.6%) after dietary intervention and 3.37 mm (–32.9%) after the 8-week treatment period. In the omega-3 fatty acid arm of the study, triglycerides fell from 5.34 mm to 5.02 mm (–6%) after dietary intervention and to 2.30 mm (–56.9%) after the treatment period. In the placebo arm of the study, triglycerides fell from 4.77 mm to 4.05 mm (–15.1%) after dietary intervention and to 4.08 mm (–14.5%) after the treatment period. Using the random effects model, a statistically significant effect on triglycerides of omega-3 fatty acid versus placebo was found (χ2 = 6.04, P = 0.0487). The estimated difference between groups for change in mean triglycerides over 8 weeks was –2.32 mm (95% CI –4.52, –0.12 mm). Conclusions: Omega-3 fatty acids are likely to be an effective treatment for hypertriglyceridaemia in HIV-infected males on HAART.
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1111/J.1469-0691.2009.02821.X
Abstract: The risk factors for and clinical features of bloodstream infection with uncommon Candida spp. (species other than C. albicans, C. glabrata, C. parapsilosis, C. tropicals and C. krusei) are incompletely defined. To identify clinical variables associated with these species that might guide management, 57 cases of candidaemia resulting from uncommon Candida spp. were analysed in comparison with 517 episodes of Candida albicans candidaemia (2001-2004). Infection with uncommon Candida spp. (5.3% of candidaemia cases), as compared with C. albicans candidaemia, was significantly more likely to be outpatient-acquired than inpatient-acquired (15 of 57 vs. 65 of 517 episodes, p 0.01). Prior exposure to fluconazole was uncommon (n=1). Candida dubliniensis was the commonest species (n=22, 39%), followed by Candida guilliermondii (n=11, 19%) and Candida lusitaniae (n=7, 12%).C. dubliniensis candidaemia was independently associated with recent intravenous drug use (p 0.01) and chronic liver disease (p 0.03), and infection with species other than C. dubliniensis was independently associated with age<65 years (p 0.02), male sex (p 0.03) and human immunodeficiency virus infection (p 0.05). Presence of sepsis at diagnosis and crude 30-day mortality rates were similar for C. dubliniensis-related, non-C. dubliniensis-related and C. albicans-related candidaemia. Haematological malignancy was the commonest predisposing factor in C. guilliermondii (n=3, 27%) and C. lusitaniae (n=3, 43%) candidaemia. The 30-day mortality rate of C. lusitaniae candidaemia was higher than the overall death rate for all uncommon Candida spp. (42.9% vs. 25%, p not significant). All isolates were susceptible to hotericin B, voriconazole, posaconazole, and caspofungin five strains (9%) had fluconazole MIC values of 16-32 mg/L. Candidaemia due to uncommon Candida spp. is emerging among hospital outpatients certain clinical variables may assist in recognition of this entity.
Publisher: CSIRO Publishing
Date: 23-08-2022
DOI: 10.1071/SH22070
Abstract: Diabetes is an increasingly common co-morbidity in people living with HIV (PLWH). Given new evidence demonstrating cardiovascular benefits of sodium glucose transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1RA) in diabetic patients, we reviewed medical charts of 262 PLWH at Monash Health through a 1-year retrospective cohort study to determine the rates of their use. Prevalence of diabetes was 13.4% (35) and 60% (21) had microvascular and macrovascular complications. Only 4% (95% CI 0.1%–19.6%) of diabetic patients were receiving SGLT2i and 19% (95% CI 6%–39.4%) were receiving GLP1RA. Prescribers should carefully consider their choice of glucose-lowering medication when treating PLWH.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-09-2015
Publisher: BMJ
Date: 23-08-2010
Publisher: Public Library of Science (PLoS)
Date: 15-02-2022
DOI: 10.1371/JOURNAL.PMED.1003904
Abstract: Deaths in the first year of the Coronavirus Disease 2019 (COVID-19) pandemic in England and Wales were unevenly distributed socioeconomically and geographically. However, the full scale of inequalities may have been underestimated to date, as most measures of excess mortality do not adequately account for varying age profiles of deaths between social groups. We measured years of life lost (YLL) attributable to the pandemic, directly or indirectly, comparing mortality across geographic and socioeconomic groups. We used national mortality registers in England and Wales, from 27 December 2014 until 25 December 2020, covering 3,265,937 deaths. YLLs (main outcome) were calculated using 2019 single year sex-specific life tables for England and Wales. Interrupted time-series analyses, with panel time-series models, were used to estimate expected YLL by sex, geographical region, and deprivation quintile between 7 March 2020 and 25 December 2020 by cause: direct deaths (COVID-19 and other respiratory diseases), cardiovascular disease and diabetes, cancer, and other indirect deaths (all other causes). Excess YLL during the pandemic period were calculated by subtracting observed from expected values. Additional analyses focused on excess deaths for region and deprivation strata, by age-group. Between 7 March 2020 and 25 December 2020, there were an estimated 763,550 (95% CI: 696,826 to 830,273) excess YLL in England and Wales, equivalent to a 15% (95% CI: 14 to 16) increase in YLL compared to the equivalent time period in 2019. There was a strong deprivation gradient in all-cause excess YLL, with rates per 100,000 population ranging from 916 (95% CI: 820 to 1,012) for the least deprived quintile to 1,645 (95% CI: 1,472 to 1,819) for the most deprived. The differences in excess YLL between deprivation quintiles were greatest in younger age groups for all-cause deaths, a mean of 9.1 years per death (95% CI: 8.2 to 10.0) were lost in the least deprived quintile, compared to 10.8 (95% CI: 10.0 to 11.6) in the most deprived for COVID-19 and other respiratory deaths, a mean of 8.9 years per death (95% CI: 8.7 to 9.1) were lost in the least deprived quintile, compared to 11.2 (95% CI: 11.0 to 11.5) in the most deprived. For all-cause mortality, estimated deaths in the most deprived compared to the most affluent areas were much higher in younger age groups, but similar for those aged 85 or over. There was marked variability in both all-cause and direct excess YLL by region, with the highest rates in the North West. Limitations include the quasi-experimental nature of the research design and the requirement for accurate and timely recording. In this study, we observed strong socioeconomic and geographical health inequalities in YLL, during the first calendar year of the COVID-19 pandemic. These were in line with long-standing existing inequalities in England and Wales, with the most deprived areas reporting the largest numbers in potential YLL.
Publisher: Mary Ann Liebert Inc
Date: 09-2004
Abstract: Clostridium septicum is an unusual human pathogen associated with colorectal malignancy and gas gangrene. A case compilation and literature review are presented. We report the case of an in idual with a comminuted tibial fracture complicated by a superficial surgical site infection with C. septicum nine weeks after the original injury and internal fixation, which was complicated by a secondary bacteremia. This is a unique case in the literature, but it is suggested that the use of cephalosporins as prophylaxis for contaminated wounds may be inferior to penicillins to prevent clostridial infections.
Publisher: Wiley
Date: 06-2021
DOI: 10.1111/IMJ.15369
Abstract: People living with human immunodeficiency virus (HIV) are at increased risk of invasive pneumococcal disease (IPD). We assessed whether patients with invasive Streptococcus pneumoniae , in blood or cerebrospinal fluid, underwent HIV serology testing over a 5‐year period. We found that only 39 inpatients out of 156 (25%) with IPD were tested for HIV and thus conclude that such testing is not being undertaken according to some guidelines in patients with IPD. Education and implementation strategies are required to increase testing.
Publisher: Public Library of Science (PLoS)
Date: 04-08-2011
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.IDH.2019.05.002
Abstract: Some patients receive long-term or life-long antibiotics for suppression of infections deemed otherwise incurable. Little is known about the consequences of this strategy. We aimed to explore patients' attitudes towards and knowledge concerning prolonged antibiotic therapy. A cross-sectional cohort pilot study of outpatients on long-term antibiotics was performed. Surveys were conducted at our healthcare network in Victoria, Australia between April and December 2015. Microbiological screening for multi-resistant organisms (MRO) was also performed. Heterogeneity was noted in the prescribed antibiotics and documented indications, with rif icin and fusidic acid for suppression of prosthetic joint infection the most common regimen and indication. 41% (12/29) of participants reported side-effects attributed to their antibiotics, but 72% (21/29) still declared complete adherence to their prescribed regimen. 76% (22/29) of participants stated that they would cease their long-term antibiotics based on medical advice. 19/29 (66%) participants consented to microbiological screening and 4 were found to be colonised with MROs. They had spent more days as an inpatient in the preceding 12 months than the screened participants who were not colonised. Participants in this study had a good understanding of their infection and the indications for their long-term antibiotic therapy, and were adherent to this therapy despite many experiencing side-effects attributed to their antibiotics. Patients who are prescribed life-long antibiotics can be carriers of multi-resistant organisms, but both the drivers of this resistance, and the broader impact of colonisation with MRO in this population is unclear.
Publisher: MDPI AG
Date: 05-01-2022
DOI: 10.3390/ANTIBIOTICS11010062
Abstract: Background: Little is known about the impacts at an in idual level of long-term antibiotic consumption. We explored health outcomes of long-term antibiotic therapy prescribed to a cohort of patients to suppress infections deemed incurable. Methods: We conducted a 5-year longitudinal study of patients on long-term antibiotics at Monash Health, a metropolitan tertiary-level hospital network in Australia. Adults prescribed antibiotics for months to suppress chronic infection or prevent recurrent infection were included. A retrospective review of medical records and a descriptive analysis was conducted. Results: Twenty-seven patients were followed up during the study period, from 29 patients originally identified in Monash Health in 2014. Seven of the 27 patients (26%) died from causes unrelated to the suppressed infection, six (22%) ceased long-term antibiotic therapy and two (7%) required treatment modification. Fifteen (56%) were colonised with multiresistant microorganisms, including vancomycin resistant Enterococci, methicillin resistant Staphylococcus aureus, and carbapenem resistant Enterobacteriaciae. Conclusions: This work highlights the potential pitfalls of long-term antibiotic therapy, and the frailty of this cohort, who are often ineligible for definitive curative therapy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-11-2022
Publisher: CSIRO Publishing
Date: 12-09-2022
DOI: 10.1071/SH22085
Abstract: Background As people living with HIV now have a life expectancy approaching that of the general population, clinical care focuses increasingly on the management and prevention of comorbidities and conditions associated with aging. We aimed to assess the prevalence of physical function (PF) limitation among gay and bisexual men (GBM) and determine whether HIV is associated with severe PF limitation in this population. Methods We analysed cross-sectional data from GBM aged ≥55 years in the Australian Positive and Peers Longevity Evaluation Study who completed a self-administered survey on health and lifestyle factors. PF was measured using the Medical Outcomes Study–Physical Functioning scale. Factors associated with severe PF limitation were assessed using logistic regression. Results The survey was completed by 381 men: 186 without HIV and 195 with HIV. Median age was 64.3 years for GBM without HIV and 62.1 years for GBM with HIV. Compared with men without HIV, those with HIV had higher proportions of severe (13.3% vs 8.1%) and moderate-to-severe (26.7% vs 24.2%) PF limitation. Severe PF limitation commonly involved difficulty with vigorous activity (95% with severe PF limitation described being limited a lot), climbing several flights of stairs (68.4% limited a lot), bending, kneeling or stooping (60.5% limited a lot), and walking 1 km (55.0% limited a lot). In a model adjusted for age, body mass index, typical duration of physical activity, psychological distress, and number of comorbidities, we found a significant association between HIV and severe PF limitation (adjusted odds ratio 3.3 vs not having HIV, 95% confidence interval 1.3–8.7). Conclusions The biological mechanisms underlying this association require further investigation, particularly given the growing age of the HIV population and inevitable increase in the burden of PF limitation.
Publisher: Wiley
Date: 12-2020
DOI: 10.1111/IMJ.15129
Publisher: Springer Science and Business Media LLC
Date: 12-08-2015
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1111/J.1467-842X.2006.TB00786.X
Abstract: Overwhelming, sometimes fatal infections represent a lifelong risk after surgical removal of the spleen, or in patients who develop hyposplenism as a consequence of illnesses. This risk may be reduced by all or a combination of vaccination, antibiotic prophylaxis and education. We aimed to determine if a registry approach to delivering these interventions would be cost effective using our own experience and published data. The decision model compared a cohort of 1,000 people covered by a registry to a cohort of 1,000 people with no registry. The impact of the registry was assessed in terms of achieved rates of vaccination, chemoprophylaxis and education, consequent outcomes of overwhelming post-splenectomy infection (OPSI) and mortality (years of life lived). The cost-effectiveness of the registry compared with no registry was estimated in terms of additional cost per case of OPSI avoided and as additional cost per life year gained. In the first two years, the additional cost of the registry was dollar 152,611 per case of OPSI avoided or dollar 205,931 per life year gained. After this initial registration period the cost-effectiveness improves over time, such that over the cohort lifetime a post-splenectomy register is associated with an additional cost of dollar 105,159 per case of OPSI avoided or dollar 16,113 per life year gained. A registry-based approach is likely to prove cost effective in terms of mortality and rates of OPSI avoided.
Publisher: Wiley
Date: 19-04-2001
DOI: 10.1016/S0014-5793(01)02370-5
Abstract: The Duffy blood group antigen is an essential receptor for Plasmodium vivax entry into erythrocytes in a process mediated by the parasite ligand, the Duffy binding protein (DBP). Recently, in iduals living in a malaria endemic region of Papua New Guinea were identified as heterozygous for a new allele conferring Duffy negativity, which results in 50% less Duffy antigen on their erythrocytes. We demonstrate that DBP adherence to erythrocytes is significantly reduced for erythrocytes from heterozygous in iduals who carry one Duffy antigen negativity allele. These data provide evidence that emergence of this new allelic form of Duffy negativity is correlated with resistance against vivax malaria.
Publisher: Medknow
Date: 2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-02-2007
Publisher: Informa UK Limited
Date: 11-04-2018
Publisher: Wiley
Date: 11-2009
Publisher: SAGE Publications
Date: 11-07-2016
Abstract: Opportunistic infections have been reported infrequently in primary HIV infection. We report a case of cryptococcemia in primary HIV infection. To our knowledge there has not been such a case reported. Our case highlights the need for clinicians to be wary of other opportunistic infections, including cryptococcosis, in primary HIV infection.
Publisher: Wiley
Date: 10-2019
DOI: 10.1111/IMJ.14717
Abstract: Infective endocarditis (IE) results in substantial morbidity and mortality in people who inject drugs (PWID). To describe the burden of IE and its outcomes in PWID. Retrospective cohort study of adults admitted to a tertiary referral centre in Melbourne, Australia, with IE due to injection drug use from 1997 to 2015. Ninety-seven PWID with 127 episodes of IE were identified with a median acute inpatient stay of 37 days (1-84). Admission to an intensive care unit was required in 67/127 (53%) episodes. Twenty-seven percent (34/127) of episodes occurred in patients with a previous episode of endocarditis. One third (43/127, 34%) of episodes involved left-sided cardiac valves. Antimicrobial treatment was completed in 88 (70%) episodes. Valve surgery was performed in 25/127 (20%) episodes. Predictors of surgery in univariable analysis were left-sided cardiac involvement (risk ratio (RR) 6.0), severe valvular regurgitation (RR 2.6) and cardiac failure (RR 2.2) (all P < 0.005). Twenty (16%) episodes resulted in death. Predictors of mortality on univariable analysis were left-sided cardiac involvement (RR 6.4), and not completing treatment (RR 0.12 both P < 0.001). The average estimated cost per episode was AU$74 168. IE causes a considerable burden of disease in PWID, with significant healthcare utilisation and cost. Surgery and death are not infrequent complications. In addition to ensuring completion of antimicrobial therapy, strategies such as opioid maintenance programmes may be useful in improving health outcomes for PWID.
Publisher: Springer Science and Business Media LLC
Date: 03-04-2019
Publisher: SAGE Publications
Date: 11-2012
Abstract: We report three cases of immigrants to Australia, living with HIV/AIDS, who, while travelling in countries of origin or migration, were unable to continue to take their antiretrovirals appropriately. We discuss the possible reasons for this and ways to reduce the possibility of it happening. Travel may be a significant risk factor for non-adherence pre-travel advice and planning might help to prevent it occurring.
Publisher: Elsevier BV
Date: 03-2001
Publisher: Mary Ann Liebert Inc
Date: 04-2021
Publisher: Springer Science and Business Media LLC
Date: 2004
DOI: 10.2165/00003495-200464070-00001
Abstract: Before highly active antiretroviral therapies (HAART) were available for the treatment of persons with HIV infection, disseminated Mycobacterium avium-intracellulare complex (MAC) infection was one of the most common opportunistic infections that affected people living with AIDS. Routine use of chemoprophylaxis with a macrolide has been advocated in guidelines for the treatment of HIV-infected in iduals if they have a circulating CD4+ cell count of 100 cells/microL. These recommendations are still conservative as primary or secondary disseminated MAC infections are only rarely seen in patients who respond to HAART, despite treatment initiation at very low CD4+ cell counts. Potential adverse effects of macrolide therapy and drug interactions with antiretrovirals also metabolised via the cytochrome P450 enzyme system must be critically weighed against the marginal benefit that MAC prophylaxis may provide in addition to treatment with HAART. These authors feel that, unless patients who initiate HAART at low CD4+ cell counts do not respond to HIV-treatment, routine MAC prophylaxis should not be recommended. Nevertheless, the patient population for whom MAC prophylaxis may still be indicated in the era of HAART needs to be identified in prospectively designed clinical trials.
Publisher: Springer Science and Business Media LLC
Date: 05-12-2022
DOI: 10.1186/S12981-022-00476-X
Abstract: There are more than 7,800 people living with human immunodeficiency virus (HIV) in Victoria, Australia. Crucial in maximising the in idual and population level benefits from antiretroviral therapy (ART) is understanding how to achieve patient retention in care and the factors that drive it. This study was an expansion of a 2015 assessment of HIV-care retention in Victoria, which sought out to determine whether the inclusion of a broader range of HIV-healthcare sites would yield more accurate estimates of retention in HIV-care. We aimed to improve our understanding of HIV-care retention in Victoria, Australia, identify people living with HIV (PLHIV) with unknown outcomes, and attempt to re-engage PLHIV in care. A network of 15 HIV-care sites was established in Victoria, Australia across erse care settings which ranged from low-caseload rural sites to high-caseload metropolitan GP clinics and hospitals. In iduals who had an HIV viral load (VL) performed in both calendar years of 2016 and 2017 were classified as retained in care. In iduals with a VL test in 2016 but not in 2017 were considered to potentially have unknown outcomes as they may have been receiving care elsewhere, have disengaged from care or died. For this group, an intervention of cross-referencing partially de-identified data between healthcare sites, and contact tracing in iduals who still had unknown outcomes was performed. For 5223 in iduals considered to be retained in care across 15 healthcare sites in the study period, 49 had unconfirmed transfers of care to an alternative provider and 79 had unknown outcomes. After the intervention, the number of unconfirmed care transfers was reduced to 17 and unknown outcomes reduced to 51. These changes were largely attributed to people being reclassified as confirmed transfers of care. Retention in care estimates that did not include the patient outcome of confirmed transfer of care ranged from 76.2 to 95.8% and did not alter with the intervention. However, retention in care estimates which considered confirmed transfers and those that re-entered care at a new site as retained in care significantly increased across five of the sites with estimates ranging from 80.9 to 98.3% pre-intervention to 83.3–100% post-intervention. In iduals whose outcomes remained unknown post-intervention were more often men who have sex with men (MSM) when compared to other categories (person who injects drugs (PWID), combined PWID/MSM, men who identify as heterosexual or unknown) (74.5% vs. 53.5%, [p = 0.06]) and receiving ART at their last HIV-care visit (84.3% vs. 67.8% [p = 0.09]). This study confirmed high retention in HIV-care and low numbers of people disengaged from HIV-care in Victoria. This was demonstrated across a larger number of sites with varying models of care than a prior assessment in 2015. These data align with national and state targets aiming for 95% of PLHIV retained in HIV-care.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-02-2017
Publisher: Informa UK Limited
Date: 27-08-2018
Publisher: Oxford University Press (OUP)
Date: 22-12-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2014
Publisher: Springer Science and Business Media LLC
Date: 22-07-2013
Abstract: Vitamin D is believed to play an important role outside the endocrine system in the regulation of the immune system, and in cellular proliferation and differentiation. The aim of the study was to investigate the impact of vitamin D levels on innate immunity. Participants for this prospective, longitudinal study were recruited amongst otherwise healthy staff of a large hospital in Victoria, Australia. Those fulfilling the inclusion criteria, including a vitamin D level of nmol/L, were supplemented. Using flow cytometry, expression of the innate immune receptors TLR2, TLR4 and CD86 was measured on peripheral blood mononuclear cells (PBMCs) collected prior to vitamin D treatment and then at 1 and 3 months. Additonally, PBMCs at each timepoint were stimulated with specific TLR ligands and resultant supernatants were assayed for the cytokines TNFα, IL-6, IFN-α and IP-10. In participants whose vitamin D level was nmol/L post supplementation (n=11), TLR2 expression on PBMCs increased significantly, with no change noted in TLR4 or CD86 expression. Stimulation of vitamin D deficient s les with TLR ligands produced a number of proinflammatory cytokines, which were significantly reduced upon vitamin D normalisation. In patients whose levels returned to a deficient level at 3 months despite ongoing low-level supplementation, an increase in the pro-inflamamtory state returned. This suggests that vitamin D may play an important role in ensuring an appropriate baseline pro-inflammatory state. This ex-vivo pilot study adds clinical evidence supporting a possibly important role for vitamin D in innate immunity. If confirmed, this unique clinical study has potentially significant implications for the treatment of a variety of inflammatory conditions, where achieving optimal vitamin D levels may help reduce inflammation.
Publisher: Elsevier BV
Date: 05-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-1998
DOI: 10.1097/00042560-199812010-00013
Abstract: Hepatitis G virus (HGV) is a new virus found in 1% to 4% of blood from all donors but is more prevalent in some immunocompromised groups, with unclear clinical significance. Frozen plasma s les from 192 AIDS patients were tested for HGV RNA 44 (23%) were positive. Positive patients did not differ from negative patients in age, gender, race, HIV infection risk factors, nor blood transfusion exposure. Hepatitis BsAg was associated with HGV infection (odds ratio [OR] = 7.7 95% confidence interval [CI], 2.4-25.0) but hepatitis C antibody was not. Mean values for liver function tests and hematologic values did not differ significantly between the groups nor did the occurrence of certain recognized AIDS-related complications. Mean CD4+ cell counts and HIV-1 plasma RNA levels were comparable in the two groups, but the mean circulating CD8+ cell count in the HGV-positive group (853+/-458 cells/microL) was higher than in the negative group (682+/-457 cells/microL p = .03). Hepatitis G virus, although common in AIDS patients, does not appear to alter the course of AIDS nor appear as a distinct hepatitis syndrome.
Publisher: American Society for Microbiology
Date: 02-2015
DOI: 10.1128/JCM.02887-14
Abstract: We report a case of Acanthamoeba encephalitis diagnosed from an antemortem brain biopsy specimen, where the organism was first isolated in mycobacterial liquid medium and first identified by using a sequence generated by a commercial panfungal sequencing assay. We correlate susceptibility results with clinical outcome.
Publisher: Springer Science and Business Media LLC
Date: 09-10-2012
DOI: 10.1007/S10096-011-1429-1
Abstract: The purpose of this study was to estimate the incidence density and prevalence of dengue virus infection in Australian travellers to Asia. We conducted a multi-centre prospective cohort study of Australian travellers over a 32-month period. We recruited 467 travellers (≥ 16 years of age) from three travel clinics who intended to travel Asia, and 387 (82.9%) of those travellers completed questionnaires and provide s les pre- and post-travel for serological testing for dengue virus infection. Demographic data, destination countries and history of vaccinations and flavivirus infections were obtained. Serological testing for dengue IgG and IgM by enzyme-linked immunosorbent assay (ELISA) (PanBio assay) was performed. Acute seroconversion for dengue infection was demonstrated in 1.0% of travellers, representing an incidence of 3.4 infections per 10,000 days of travel (95% confidence interval [CI]: 0.9-8.7). The seroprevalence of dengue infection was 4.4% and a greater number of prior trips to Asia was a predictor for dengue seroprevalence (p = 0.019). All travellers experienced subclinical dengue infections and had travelled to India (n = 3) and China (n = 1). This significant attack rate of dengue infection can be used to advise prospective travellers to dengue-endemic countries.
Publisher: Wiley
Date: 24-09-2009
DOI: 10.1111/J.1423-0410.2009.01203.X
Abstract: The Duffy blood group (Fy) antigen functions as the receptor whereby the malarial parasite Plasmodium vivax invades reticulocytes. In this study, we evaluated an autologous blood donation model to measure Fy expression during the anticipated response to blood loss. This study aims to examine Fy expression following anticipated reticulocytosis in response to blood loss from autologous whole blood donation. Subjects were healthy blood donors presenting for planned collection of two or three autologous units. Whole blood (450 ml +/- 10%) was collected and processed. Blood s les for Fy testing were obtained from the donations. These were assayed by flow cytometry by measuring binding of a phycoerythrin-labelled anti-Fy6 antibody and compared against reticulocyte numbers. Reticulocyte numbers were measured using thiazole orange. Results were compared from baseline (first donation) with s les at second and, if available, third, donations. Phenotyping for Fy a and b antigens was performed. Reticulocytes increased by a mean of 37% over baseline [0.93% (range 0.31-1.93) to 1.23% (0.32-3.51%)] following donation of two (n = 32) or three (n = 9) autologous whole blood units. Absolute reticulocyte count remained low. Mean and median Fy expression on mature red blood cells and reticulocytes did not change from baseline levels despite in idual variation. No apparent relationship to serologically determined Fy a and/or b antigen status was present. Baseline expression of Fy antigen on mature red blood cells and reticulocytes is quite variable between in iduals, but appears not to be greatly affected by mild to moderate reticulocytosis following blood loss in an autologous blood donation model.
Publisher: Wiley
Date: 26-07-2007
DOI: 10.1111/J.1468-1293.2007.00478.X
Abstract: The aim of the study was to describe the prevalence of and risk factors for HIV-associated sensory neuropathy (HIV-SN) in 2006 [the era of stavudine, didanosine and zalcitabine (dNRTI)-sparing highly active antiretroviral therapy (HAART)] and to compare our findings with data obtained in the same clinic in 1993 (pre-HAART) and 2001 (frequent use of dNRTI-containing HAART). This was a cross-sectional comparative study using convenience s ling. HIV-positive adults attending a tertiary referral clinic over a 2-week period were screened for HIV-SN using the AIDS Clinical Trials Group screening tool. HIV-SN was defined as present if the patient had both neuropathic symptoms and abnormal signs. Demographic, clinical, laboratory and treatment data were considered as possible risk factors for HIV-SN, and results were compared with data obtained in the same clinic in 1993 and 2001. One hundred patients were screened. The prevalence of HIV-SN was 42%, which was unchanged since 2001 (44%) despite a significant reduction in the use of dNRTIs. HIV-SN remained much more common than in 1993 (42% vs 13% P<0.0001). The only independent associations with HIV-SN in 2006 were increasing patient age and a history of exposure to either stavudine or indinavir. This compares with 1993 when neuropathy was increased in those with Mycobacterium avium complex infection, and 2001 when patient age and use of stavudine and didanosine were the independent associations with HIV-SN in this clinic. HIV-SN remained common among ambulatory patients in 2006 (42% prevalence) despite a significant reduction in the use of dNRTIs. In addition to patient age and stavudine exposure, indinavir use may be a risk factor for HIV-SN.
Publisher: Elsevier BV
Date: 12-2006
DOI: 10.1071/HI06123
Publisher: Research Square Platform LLC
Date: 21-11-2020
DOI: 10.21203/RS.3.RS-106576/V1
Abstract: People with HIV have higher rates of certain comorbidities, particularly cardiovascular disease and some malignancies, than people without HIV. As somatic mutations associated with age related clonal haematopoiesis (CH) are linked to similar comorbidities in the general population, we hypothesized that CH may be more prevalent in people with HIV. To address this issue, we established a prospective cohort study recruiting 220 HIV-positive and 226 HIV negative participants aged 55 years or older in Australia. Demographic characteristics, clinical data and peripheral blood were collected to assess for the presence of CH mutations and identify potential risk factors for and clinical sequelae of CH. Investigators testing for CH were blinded to participants’ HIV status. In total, 132 CH mutations were identified in 99 (22.2%) of 446 participants. CH was more prevalent in HIV-positive participants than HIV-negative participants (27.7% vs. 16.8%, p =0.006), overall and across all age groups. HIV infection was associated with an increased odds of having CH (adjusted odds ratio 2.10, 95% confidence interval 1.30-3.38, p=0.002). The most common genes mutated were DNMT3A (48.5%), TET2(20.5%) and ASXL1 (11.4%). CH and HIV infection were independently associated with increases in blood parameters and biomarkers associated with inflammation. These data suggest a selective advantage for the emergence of CH in the context of chronic infection and inflammation related to HIV infection.
Publisher: Public Library of Science (PLoS)
Date: 26-05-2015
Publisher: Oxford University Press (OUP)
Date: 05-04-2016
DOI: 10.1093/CID/CIW207
Publisher: Wiley
Date: 26-11-2019
DOI: 10.1111/HIV.12689
Abstract: As HIV-positive people age, diagnosis and management of comorbidities associated with ageing are of increasing concern. In this study, we aimed to compare the self-reported prevalences of heart disease, stroke, thrombosis and diabetes in older Australian HIV-positive and HIV-negative gay and bisexual men (GBM). We analysed data from the Australian Positive & Peers Longevity Evaluation Study (APPLES), a study of a prospectively recruited cross-sectional s le of 228 (51.1%) HIV-positive and 218 (48.9%) HIV-negative GBM, aged ≥ 55 years. Regression methods were used to assess the association of HIV status with self-reported comorbidities. Of 446 patients, 389 [200 (51.4%) HIV-positive] reported their disease history. The reported prevalence of comorbidities was higher in the HIV-positive group than in the HIV-negative group: heart disease, 19.5 versus 12.2% stroke, 7.5 versus 4.2% thrombosis, 10.5 versus 4.2% and diabetes, 15.0 versus 9.0%, respectively. In adjusted analyses, HIV-positive GBM had significantly increased odds of reporting heart disease [adjusted odds ratio (aOR) 1.99 P = 0.03] and thrombosis (aOR 2.87 P = 0.01). In our analysis, HIV status was not significantly associated with either age at diagnosis of heart disease (median 53 years for HIV-positive GBM versus 55 years for HIV-negative GBM P = 0.64) or 5-year cardiovascular disease (CVD) risk estimated using the Framingham risk score. HIV-positive GBM more commonly reported heart disease and thrombosis compared with their HIV-negative peers. These results further highlight the need to understand the impact of HIV on age-related comorbidities in GBM, to guide optimal screening and treatment strategies to reduce the risk of these comorbidities among the HIV-positive population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 26-10-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-09-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2022
Publisher: Elsevier BV
Date: 10-2018
Abstract: To validate our estimates from our original model and re-evaluate the cost-effectiveness of Spleen Australia, the Australian post-splenectomy registry, using our original model with updated model parameters based on advances in the literature and experience of the registry over the past decade. We revisited a decision model from 2005, comparing 1,000 hypothetical registered patients with asplenia or hyposplenism against 1,000 who were not registered, and updated the model parameters. The cost-effectiveness of the registry was evaluated from a healthcare perspective in terms of additional cost per case of overwhelming post-splenectomy infection (OPSI) avoided and as additional cost per life year gained. Over a cohort lifetime the registry was associated with an additional cost of $125,724 per case of OPSI avoided or $19,286 per life year gained. Despite our initial over-estimation of immunisation and chemoprophylaxis uptake and increases in unit costs, our re-evaluation confirmed use of the registry to be cost-effective. Implications for public health: Improved outcomes for patients with asplenia or hyposplenism can be achieved by a cost-effective registry. Additional research into effectiveness of interventions, OPSI prevalence associated with varying intervention use, and compliance rates over time after registration would provide improved accuracy of cost-effectiveness estimates.
Publisher: No publisher found
Date: 2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 31-07-2010
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Ian John Woolley.