ORCID Profile
0000-0001-9249-1780
Current Organisation
Alfred Health
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Publisher: Wiley
Date: 11-06-2022
DOI: 10.1111/IMJ.15423
Abstract: The incidence of end‐stage organ disease in people living with human immunodeficiency virus (HIV) (PLWH) is increasing, as people live longer due to potent, tolerable antiretroviral therapy (ART). Consequently, the number of PLWH who would benefit from solid organ transplant (SOT) is rising. The SOT experience in PLWH in Australia remains limited. Aim To retrospectively review the outcomes for SOT in PLWH at our service, in Victoria, Australia. A retrospective cohort study of PLWH undergoing SOT over a 15‐year period was performed. Adult PLWH age years were eligible and identified from the Victorian HIV Service database. Descriptive statistics were used to summarise baseline demographics and clinical data, and outcomes following SOT. Nine virologically suppressed PLWH underwent SOT from HIV‐negative donors (five kidneys, two livers and two bilateral sequential lung transplants). All patients were male, with a median age of 57.3 years (interquartile range (IQR) = 54.3–60.1) and CD4 count of 485 (IQR = 342–835) at transplantation, and comorbidities were common at baseline. After a median follow up of 3.9 years (IQR = 2.7–7.6), 8 (89%) patents were alive, 7 (78%) had functioning grafts, although 5 (56%) experienced organ rejection. Infections were common. Two patients required modification to their ART due to significant drug−drug interactions prior to transplant, while 5 (56%) had modifications post‐SOT. No patients experienced HIV virologic failure. PLWH with end‐stage organ disease experience good clinical and functional outcomes and should be considered for SOT where indicated. However, multidisciplinary planning and care is essential to optimise care in this patient group.
Publisher: Wiley
Date: 04-12-2020
DOI: 10.1111/TID.13510
Publisher: Massachusetts Medical Society
Date: 10-08-2023
DOI: 10.1056/NEJMC2307375
Publisher: Wiley
Date: 09-04-2019
DOI: 10.5694/MJA2.50133
Publisher: Oxford University Press (OUP)
Date: 10-2019
Abstract: Salmonella species are major contributors to the global burden of foodborne disease. While typhoidal salmonella (TS) is typically associated with travel in high-income settings, non-typhoidal salmonella (NTS) is more commonly associated with locally acquired diarrhoeal disease. We aimed to assess the epidemiology, antimicrobial resistance (AMR) patterns, and clinical markers of Salmonella bloodstream infections (BSI) in Victoria, Australia. We conducted a retrospective audit of blood culture results over a 5.5-year period at a large, private pathology provider, in Victoria, Australia. All Salmonella isolates detected in blood between January 2013 and June 2018 were included. Epidemiological, microbiological, AMR and clinical data were extracted from the pathology record and collated for analysis. Of 27,546 positive blood cultures, 262 were positive for Salmonella spp. (rate 9.51 per 1,000 positive cultures) in 187 episodes. 113 (60%) were NTS (47.8% S. Typhimurium, 9.7% S. Enteritidis), while 74 (40%) were TS (59% S. Typhi, 41% S. Paratyphi). Patients with TS were younger (median age 29 vs. 65, P 0.0001), more likely to have traveled [OR 125 (95% CI 28.47, 549], but fewer had a positive stool [OR 0.21 (95% CI 0.08–0.58)] than those with NTS. NTS was associated with a higher median CRP (149 vs. 83, P 0.001) and more frequently associated with an abnormal white cell count (39% vs. 18%, P = 0.003). Quinolone non-susceptibility was stable with time, and occurred more frequently in TS than NTS (71 vs. 23%, P 0.0001). Non-susceptibility to Azithromycin was also common in TS (42%), and increasing with time (P = 0.02). Non-susceptibility to ≥1 antibiotic occurred in 54 (73%) of TS, while 24 (32%) had non-susceptibility ≥2. Ceftriaxone resistance occurred infrequently in both NTS and TS (2 vs. 0%, P = 0.5). Salmonella is an uncommon cause of BSI in our setting, with similar proportions of TS and NTS. Typhoidal isolates were more likely to be associated with travel, and antimicrobial resistance. Despite this, ceftriaxone remains a reliable option for first-line therapy for both TS and NTS. Quinolone resistance remains common, while Azithromycin resistance has increased with time in TS. All authors: No reported disclosures.
Publisher: Oxford University Press (OUP)
Date: 26-05-2023
DOI: 10.1093/CID/CIAD321
Abstract: Patients without human immunodeficiency virus (HIV) are increasingly recognized as being at risk for cryptococcosis. Knowledge of characteristics of cryptococcosis in these patients remains incomplete. We conducted a retrospective study of cryptococcosis in 46 Australian and New Zealand hospitals to compare its frequency in patients with and without HIV and describe its characteristics in patients without HIV. Patients with cryptococcosis between January 2015 and December 2019 were included. Of 475 patients with cryptococcosis, 90% were without HIV (426 of 475) with marked predominance in both Cryptococcus neoformans (88.7%) and Cryptococcus gattii cases (94.3%). Most patients without HIV (60.8%) had a known immunocompromising condition: cancer (n = 91), organ transplantation (n = 81), or other immunocompromising condition (n = 97). Cryptococcosis presented as incidental imaging findings in 16.4% of patients (70 of 426). The serum cryptococcal antigen test was positive in 85.1% of tested patients (319 of 375) high titers independently predicted risk of central nervous system involvement. Lumbar puncture was performed in 167 patients to screen for asymptomatic meningitis, with a positivity rate of 13.2% where meningitis could have been predicted by a high serum cryptococcal antigen titer and/or fungemia in 95% of evaluable cases. One-year all-cause mortality was 20.9% in patients without HIV and 21.7% in patients with HIV (P = .89). Ninety percent of cryptococcosis cases occurred in patients without HIV (89% and 94% for C. neoformans and C. gattii, respectively). Emerging patient risk groups were evident. A high level of awareness is warranted to diagnose cryptococcosis in patients without HIV.
Publisher: Wiley
Date: 08-2021
DOI: 10.1111/IMJ.15255
Publisher: Inderscience Publishers
Date: 2013
Publisher: Wiley
Date: 09-10-2021
DOI: 10.5694/MJA2.51298
Publisher: Oxford University Press (OUP)
Date: 11-2018
Publisher: AMPCo
Date: 24-02-2020
DOI: 10.5694/MJA2.50519
Publisher: Wiley
Date: 12-2020
DOI: 10.1111/IMJ.15083
Publisher: European Respiratory Society (ERS)
Date: 2023
Publisher: AMPCo
Date: 11-2013
DOI: 10.5694/MJA13.10953
Publisher: Elsevier BV
Date: 04-2020
DOI: 10.1016/J.MSARD.2019.101923
Abstract: Fingolimod, a sphingosine-1-phosphate modulator used in the treatment of relapsing-remitting multiple sclerosis, has been associated with several cases of cryptococcosis. We present a case of Cryptococcal meningoencephalitis attributable to Cryptococcus neoformans var. grubii, in a 58-year-old bird-keeper from Australia, after 7 years of fingolimod therapy. We discuss this in the context of previously reported cases, our understanding of fingolimod immune modulation, and known Cryptococcus pathobiology. We suggest consideration of harm minimisation behaviours in patients requiring fingolimod, particularly in those with profound CD4 lymphopenia. Furthermore, we echo the call for improved post-marketing surveillance systems to determine the epidemiology of atypical infections with novel immunomodulatory treatments.
Publisher: Oxford University Press (OUP)
Date: 16-03-2019
DOI: 10.1093/OFID/OFZ131
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-04-2023
DOI: 10.1097/QAD.0000000000003579
Abstract: People with HIV (PWH) experience a greater risk of morbidity and mortality following COVID-19 infection, and poorer immunological responses to several vaccines. We explored existing evidence regarding the immunogenicity, effectiveness, and safety of SARS-CoV-2 vaccines in PWH compared with controls. We conducted a systematic search of electronic databases from January 2020 until June 2022, in addition to conference databases, to identify studies comparing clinical, immunogenicity, and safety in PWH and controls. We compared results between those with low ( cells/μl) and high ( cells/μl) CD4 + T-cell counts where possible. We performed a meta-analysis of seroconversion and neutralization responses to calculate a pooled risk ratio as the measure of effect. We identified 30 studies, including four reporting clinical effectiveness, 27 immunogenicity, and 12 reporting safety outcomes. PWH were 3% [risk ratio 0.97, 95% confidence interval (95% CI) 0.95–0.99] less likely to seroconvert and 5% less likely to demonstrate neutralization responses (risk ratio 0.95, 95% CI 0.91–0.99) following a primary vaccine schedule. Having a CD4 + T-cell count less than 350 cells/μl (risk ratio 0.91, 95% CI 0.83–0.99) compared with a CD4 + T-cell count more than 350 cells/μl, and receipt of a non-mRNA vaccine in PWH compared with controls (risk ratio 0.86, 95% CI 0.77–0.96) were associated with reduced seroconversion. Two studies reported worse clinical outcomes in PWH. Although vaccines appear well tolerated in PWH, this group experience poorer immunological responses following vaccination than controls, particularly with non-mRNA vaccines and low CD4 + T-cell counts. PWH should be prioritized for mRNA COVID-19 vaccines, especially PWH with more advanced immunodeficiency.
No related grants have been discovered for David Griffin.