Incidence of syphilis seroconversion among HIV-infected persons in Asia: results from the TREAT Asia HIV Observational Database

INTRODUCTION: Outbreaks of syphilis have been described among HIV-infected men who have sex with men (MSM) in Western communities, whereas reports in Asian countries are limited. We aimed to characterize the incidence and temporal trends of syphilis among HIV-infected MSM compared with HIV-infected non-MSM in Asian countries. METHODS: Patients enrolled in the TREAT Asia HIV Observational Database cohort and with a negative non-treponemal test since enrolment were analyzed. Incidence of syphilis seroconversion, defined as a positive non-treponemal test after previously testing negative, was evaluated among patients at sites performing non-treponemal tests at least annually. Factors associated with syphilis seroconversion were investigated at sites doing non-treponemal testing in all new patients and subsequently testing routinely or when patients were suspected of having syphilis. RESULTS: We included 1010 patients from five sites that performed non-treponemal tests in all new patients; those included had negative non-treponemal test results during enrolment and subsequent follow-ups. Among them, 657 patients were from three sites conducting regular non-treponemal testing. The incidence of syphilis seroconversion was 5.38/100 person-years (PY). Incidence was higher in MSM than non-MSM (7.64/100 PY vs. 2.44/100 PY, p<0.001). Among MSM, the incidence rate ratio (IRR) for every additional year from 2009 was 1.19 (p=0.051). MSM status (IRR 3.48, 95% confidence interval (CI) 1.88-6.47), past syphilis diagnosis (IRR 5.15, 95% CI 3.69-7.17) and younger age (IRR 0.84 for every additional 10 years, 95% CI 0.706-0.997) were significantly associated with syphilis seroconversion. CONCLUSIONS: We observed a higher incidence of syphilis seroconversion among HIV-infected MSM and a trend to increasing annual incidence. Regular screening for syphilis and targeted interventions to limit transmission are needed in this population.ope

Comparison of Clinical Outcomes for Glycopeptides and Beta-Lactams in Methicillin-Susceptible Staphylococcus Aureus Bloodstream Infections

Purpose: This study aimed to provide compelling evidence of anti-staphylococcal beta-lactam use for methicillin-susceptible Staphylococcus aureus bloodstream infection (MSSA BSI). Materials and methods: We retrospectively collected data on patients with MSSA BSI who were admitted to two academic tertiary-care hospitals from 2010 to 2018. Only patients who received nafcillin, cefazolin, vancomycin, or teicoplanin as definitive therapy were included. The primary outcome was 28-day mortality. To perform unbiased comparisons between both treatments, we used inverse probability of treatment weighting (IPTW) analysis. Results: A total of 359 patients were divided into two groups based on the definitive therapy used: beta-lactams (n=203), including nafcillin or cefazolin; and glycopeptides (n=156), including vancomycin or teicoplanin. In the IPTW analysis, glycopeptides were associated with significantly increased odds of 28-day mortality (adjusted odds ratio, 3.37; 95% confidence interval, 1.71-6.61; p<0.001). The rate of primary outcome in prespecified subgroups was largely consistent with the main analysis. Conclusion: Definitive therapy with beta-lactams in patients with MSSA BSI was associated with lower 28-day mortality compared to definitive therapy with glycopeptides.ope

Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2020 through June 2021

Background: The Korean National Healthcare-associated Infections Surveillance System (KONIS) is a nationwide surveillance network established by the Korean Society for Healthcare-Associated Infection and Prevention in July 2006 to perform healthcare-associated infection surveillance using standardized methods. This report presents the annual data of the intensive care unit (ICU) module of the KONIS system between July 2020 and June 2021. Methods: We performed prospective surveillance of healthcare-associated infections (HAIs), including urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU), at 339 ICUs in 257 hospitals using the KONIS database. HAI rates and device-associated infection (DAI) rates were calculated as the numbers of infections per 1,000 patient days (PD) and device days (DD), respectively. Device utilization was calculated as the ratio (DUR) of device days to patient days. Results: A total of 4,435 HAIs were found during the study period: 1,645 UTIs (1,589 cases were urinary catheter-associated), 1,994 BSIs (1,753 were central line-associated), and 796 PNEUs (383 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTI) was 1.30 cases per 1,000 DD (95% confidence interval [CI], 1.24-1.36) and DUR was 0.74 (95% CI, 0.739-0.741). The rate of central line-associated BSIs was 2.21/1,000 DD (95% CI, 2.11-2.31) and DUR was 0.48 (95% CI, 0.479-0.481). The rate of ventilator-associated PNEUs was 0.79/1,000 DD (95% CD, 071-0.87) and DUR was 0.29 (95% CI, 0.289-0.291). Conclusion: The overall DAI rate was similar to that of the previous year’s data; however, the rate of VAP showed a trend of decline. Furthermore, all DURs were reduced. Therefore, continuous infection surveillance may reduce infection rates and device use.ope

The Prevalence and Risk Factors of Renal Insufficiency among Korean HIV-Infected Patients: The Korea HIV/AIDS Cohort Study

BACKGROUND: Renal disease is one of the leading causes of morbidity and mortality among people infected with human immunodeficiency virus (HIV). However, there are very few published studies about renal insufficiency in HIV-infected persons in Asia, especially in South Korea. MATERIALS AND METHODS: A cross-sectional study was performed to investigate the prevalence and risk factors of renal insufficiency, defined as <60 mL/min/1.73 m², in subjects in the Korea HIV/AIDS Cohort Study enrolled from 19 institutions between December 2006 and July 2013. Data at entry into the cohort were analyzed. RESULTS: Of 454 enrolled subjects, 24 (5.3%) showed renal insufficiency at entry into the cohort. The mean age of patients in the renal insufficiency group was 5.28 years and the majority were male subjects (91.7%). All the patients were receiving antiretroviral agents, mostly protease inhibitor-based regimens (76.4%), for an average of 19 months. In univariate analysis, older age (P = 0.002), diabetes mellitus (DM) (P = 0.0002), unknown route of transmission (P = 0.007), and taking indinavir (P = 0.0022) were associated with renal insufficiency. In multivariable analysis, older age [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.03-1.12, P = 0.002], DM [OR 3.03, 95% CI 1.17-7.82, P = 0.022], unknown route of transmission [OR 6.15, 95% CI 1.77-21.33, P = 0.004], and taking indinavir [OR 3.07, 95% CI 1.17-8.05, P = 0.023] were independent risk factors of renal insufficiency. CONCLUSION: The prevalence of renal insufficiency in HIV-infected subjects in this study was relatively low, similar to that in other countries. Aging, DM, and taking indinavir were significantly associated with decreased glomerular filtration rate. Furthermore, unknown route of transmission was an independent risk factor, which was interpreted as a reflection of patient compliance. Further studies on the incidence and risk factors of renal insufficiency during HIV infection using follow-up cohort data are necessary.ope

Survival Trend of HIV/AIDS Patients Starting Antiretroviral Therapy in South Korea between 2001 and 2015

Purpose: In the recent antiretroviral therapy (ART) era, a large proportion of Korean patients with human immunodeficiency virus (HIV) infection were shown to have low CD4 cell counts at diagnosis and during ART initiation. We investigated the survival trends in patients living with HIV/acquired immunodeficiency syndrome (AIDS) in Korea who started ART in the 2000s, and evaluated the risk factors for mortality to elucidate the association between survival and low CD4 cell counts at ART initiation. Materials and methods: Patients with HIV infection who were aged >18 years and had started ART between 2001 and 2015 in the Korean HIV/AIDS cohort study were enrolled. We compared the clinical characteristics, mortality, and causes of death among the enrolled subjects based on the time of ART initiation. Cox regression analysis was used to estimate the adjusted hazard ratios of mortality based on the time of ART initiation. Results: Among the 2474 patients enrolled, 105 (4.24%) died during the follow-up period of 9568 patient-years. Although CD4 cell counts at the time of ART initiation significantly increased from 161 [interquartile range (IQR), 73.5-303] in 2001-2003 to 273 (IQR, 108-399) in 2013-2015 (p40 years [adjusted hazard ratio, 3.71; 95% confidence interval (CI), 2.35-5.84] and low CD4 counts (<100 cells/mm³: adjusted hazard ratio, 2.99; 95% CI, 1.44-6.23) were significant risk factors for mortality. Conclusion: Despite excellent HIV care available in the recent ART era, the survival of patients with HIV/AIDS undergoing ART did not improve between 2001 and 2015 in Korea.ope

Characteristics of Faecal Microbiota in Korean Patients with Clostridioides difficile-associated Diarrhea

BACKGROUND: The intestinal microbiota plays an important role in the pathogenesis of Clostridioides difficile-associated diarrhea, and regional and racial characteristics influence the microbiome composition and diversity. We investigated the intestinal microbiome characteristics of patients with C. difficile colitis (CD+) compared to those of patients with colitis not due to C. difficile (CD-), patients with vancomycin-resistant enterococci (VRE) colonization, and healthy controls, in Korea. MATERIALS AND METHODS: We collected stool samples from 24, 18, 11 and 13 subjects within CD+, CD-, VRE and healthy control groups, respectively. The microbial communities were evaluated by 454-pyrosequencing of bacterial 16s rRNA. RESULTS: The species richness and microbial diversity were significantly lower in the CD+ group compared to those in healthy controls, but not compared to those in CD- and VRE groups. Phylum-level analysis showed that the proportion of Actinobacteria in the CD+ group was significantly lower than in the healthy control, but was unchanged compared to that in CD- and VRE groups. At the genus level, compared to the healthy group, the CD+ group showed significantly lower proportions of Blautia, Bifidobacterium, Faecalibacterium et al. Compared to the VRE group, the CD+ group showed a significantly higher proportion of Anaerostipes. CONCLUSIONS: We could identify the intestinal microbiome characteristics of Koreans with C. difficile colitis. It might help to develop microbiome based diagnostic and treatment modalities.ope

Campylobacter hyointestinalis Isolated From a Human Stool Specimen

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Safety and immunogenicity of two recombinant DNA COVID-19 vaccines containing the coding regions of the spike or spike and nucleocapsid proteins: an interim analysis of two open-label, non-randomised, phase 1 trials in healthy adults

Background: We assessed the safety and immunogenicity of two recombinant DNA vaccines for COVID-19: GX-19 containing plasmid DNA encoding the SARS-CoV-2 spike protein, and GX-19N containing plasmid DNA encoding the SARS-CoV-2 receptor-binding domain (RBD) foldon, nucleocapsid protein, and plasmid DNA encoding the spike protein. Methods: Two open-label non-randomised phase 1 trials, one of GX-19 and the other of GX-19N were done at two hospitals in South Korea. We enrolled healthy adults aged 19-49 years for the GX-19 trial and healthy adults aged 19-54 years for the GX-19N trial. Participants who tested positive by serological testing for SARS-CoV-2 were excluded. At 4-week intervals, the GX-19 trial participants received two vaccine doses (either 1·5 mg or 3·0 mg), and the GX-19N trial participants received two 3·0 mg doses. The vaccines were delivered intramuscularly using an electroporator. The participants were followed up for 52 weeks after first vaccination. Data collected up to day 57 after first vaccination were analysed in this interim analysis. The primary outcome was safety within 28 days after each vaccination measured in the intention-to-treat population. The secondary outcome was vaccine immunogenicity using blood samples collected on day 43 or 57 after first vaccination measured in the intention-to-treat population. The GX-19 (NCT044445389) and GX-19N (NCT04715997) trials are registered with ClinicalTrials.gov. Findings: Between June 17 and July 30, 2020, we screened 97 individuals, of whom 40 (41%) participants were enrolled in the GX-19 trial (20 [50%] in the 1·5 mg group and 20 [50%] in the 3·0 mg group). Between Dec 28 and 31, 2020, we screened 23 participants, of whom 21 (91%) participants were enrolled on the GX-19N trial. 32 (52%) of 61 participants reported 80 treatment-emergent adverse events after vaccination. All solicited adverse events were mild except one (2%) case of moderate fatigue in the 1·5 mg GX-19 group; no serious vaccine-related adverse events were detected. Binding antibody responses increased after second dose of vaccination in all groups (p=0·0002 in the 1·5 mg GX-19 group; p<0·0001 in the 3·0 mg GX-19; and p=0·0004 for the spike protein and p=0·0001 for the RBD in the 3·0 mg GX-19N group). Interpretation: GX-19 and GX-19N are safe and well tolerated. GX-19N induces humoral and broad SARS-CoV-2-specific T-cell responses. GX-19N shows lower neutralising antibody responses and needs improvement to enhance immunogenicity. Funding: The Korea Drug Development Fund, funded by the Ministry of Science and ICT, Ministry of Trade, Industry, and Energy, and Ministry of Health and Welfare.ope

Soluble IL-2R Levels Predict in-Hospital Mortality in COVID-19 Patients with Respiratory Failure

Acute respiratory distress syndrome is the primary cause of death in patients with coronavirus disease 2019 (COVID-19) pneumonia. Our study aims to determine the association between serum markers and mortality in COVID-19 patients with respiratory failure. This retrospective study was conducted in a tertiary care hospital in South Korea. Forty-nine patients with COVID-19, who required high flow nasal cannulation or mechanical ventilation from February 2020 to April 2021, were included. Demographic and laboratory data were analyzed at baseline and on Day 7 of admission. We found that serum creatinine, troponin, procalcitonin, and soluble interleukin-2 receptor (sIL-2R) at baseline were more elevated in the non-survivor group, but were not associated with mechanical ventilator use on Day 7. Older age, PaO2/FiO2 ratio, lymphocyte and platelet counts, lactate dehydrogenase, IL-6, C-reactive protein, and sIL-2R on Day 7 were significantly associated with mortality. Delta sIL-2R (Day 7-Day 0) per standard deviation was significantly higher in the non-survivor group (adjusted hazard ratio 3.225, 95% confidence interval (CI) 1.151-9.037, p = 0.026). Therefore, sIL-2R could predict mortality in COVID-19 patients with respiratory failure. Its sustained elevation suggests a hyper-inflammatory state, and mirrors the severity of COVID-19 in patients with respiratory failure, thereby warranting further attention.ope

Human Immunodeficiency Virus (HIV) and Hepatitis Virus Coinfection among HIV-Infected Korean Patients: The Korea HIV/AIDS Cohort Study

BACKGROUND: Despite declines in mortality and morbidity rates of patients with human immunodeficiency virus (HIV) infection as the result of highly active antiretroviral therapy, liver diseases due to chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are a leading cause of death among HIV-infected patients. However, HIV and HBV or HCV coinfection is still poorly documented, and more information is needed to better understand the characteristics of HIV-infected patients in Korea. MATERIALS AND METHODS: A cross-sectional study was performed to investigate clinical characteristics and prevalence of HBV and HCV infection in HIV patients enrolled in the Korea HIV/acquired immune deficiency syndrome (AIDS) cohort study from 17 institutions between December 2006 and July 2013. RESULTS: Among the 1,218 HIV-infected participants, 541 were included in this study. The prevalence of HBV-HIV and HCV-HIV coinfection was 5.0% (27/541) and 1.7% (9/541), respectively. There was no patient who was positive for both HBs antigen and HCV antibody. In multivariate logistic regression analysis, HBV unvaccinated status was a significant risk factor for HBV-HIV coinfection (odds ratio = 4.95, 95% confidence interval = 1.43-17.13). CONCLUSIONS: HBV and HCV infection was more common in HIV-infected persons enrolled in the Korean HIV/AIDS cohort, than in the general population in Korea.ope