Adjunctive dexamethasone for tuberculous meningitis in HIV-positive adult

BACKGROUND Adjunctive glucocorticoids are widely used to treat human immunodeficiency virus (HIV)–associated tuberculous meningitis despite limited data supporting their safety and efficacy. METHODS We conducted a double-blind, randomized, placebo-controlled trial involving HIV-positive adults (≥18 years of age) with tuberculous meningitis in Vietnam and Indonesia. Participants were randomly assigned to receive a 6-to-8-week tapering course of either dexamethasone or placebo in addition to 12 months of antituberculosis chemotherapy. The primary end point was death from any cause during the 12 months after randomization. RESULTS A total of 520 adults were randomly assigned to receive either dexamethasone (263 participants) or placebo (257 participants). The median age was 36 years; 255 of 520 participants (49.0%) had never received antiretroviral therapy, and 251 of 484 participants (51.9%) with available data had a baseline CD4 count of 50 cells per cubic millimeter or less. Six participants withdrew from the trial, and five were lost to follow-up. During the 12 months of follow-up, death occurred in 116 of 263 participants (44.1%) in the dexamethasone group and in 126 of 257 participants (49.0%) in the placebo group (hazard ratio, 0.85; 95% confidence interval, 0.66 to 1.10; P=0.22). Prespecified analyses did not reveal a subgroup that clearly benefited from dexamethasone. The incidence of secondary end-point events, including cases of immune reconstitution inflammatory syndrome during the first 6 months, was similar in the two trial groups. The numbers of participants with at least one serious adverse event were similar in the dexamethasone group (192 of 263 participants [73.0%]) and the placebo group (194 of 257 participants [75.5%]) (P=0.52). CONCLUSIONS Among HIV-positive adults with tuberculous meningitis, adjunctive dexamethasone, as compared with placebo, did not confer a benefit with respect to survival or any secondary end point. (Funded by the Wellcome Trust; ACT HIV ClinicalTrials.gov number, NCT03092817. opens in new tab.

Discovery of Novel Backusella (Backusellaceae, Mucorales) Isolated from Invertebrates and Toads in Cheongyang, Korea

Three novel fungal species, Backusella chlamydospora sp. nov., B. koreana sp. nov., and B. thermophila sp. nov., as well as two new records, B. oblongielliptica and B. oblongispora, were found in Cheongyang, Korea, during an investigation of fungal species from invertebrates and toads. All species are described here using morphological characters and sequence data from internal transcribed spacer sequences of ribosomal DNA and large subunit of the ribosomal DNA. Backusella chlamydospora is different from other Backusella species by producing chlamydospores. Backusella koreana can be distinguished from other Backusella species by producing abundant yeast-like cells. Backusella thermophila is characterized by a variable (subglobose to oblong, applanate to oval, conical and ellipsoidal to pyriform) columellae and grows well at 37 ◦C. Multigene phylogenetic analyses of the combined ITS and LSU rDNA sequences data generated from maximum likelihood and MrBayes analyses indicate that B. chlamydospora, B. koreana, and B. thermophila form distinct lineages in the family Backusellaceae. Detailed descriptions, illustrations, phylogenetic tree, and taxonomic key to the Backusella species present in Korea are provided

Feeding ecology of the common sun skink, Eutropis multifasciata (Reptilia: Squamata: Scincidae), in the plains of central Vietnam

Ngo, Chung D., Ngo, Binh V., Hoang, Thuong T., Nguyen, Thi T.T., Dang, Hai P. (2015): Feeding ecology of the common sun skink, Eutropis multifasciata (Reptilia: Squamata: Scincidae), in the plains of central Vietnam. Journal of Natural History 49 (39): 2417-2436, DOI: 10.1080/00222933.2015.102187

Figure 2 in Feeding ecology of the common sun skink, Eutropis multifasciata (Reptilia: Squamata: Scincidae), in the plains of central Vietnam

Figure 2. Expected prey-taxon accumulation curves from the data of (A) stomach contents and (B) food item counts consumed by Eutropis multifasciata in the plains of central Vietnam. Circles represent the expected mean values, and the graphs show the 95% confidence intervals for male (filled circles) and female (open circles) skinks.Published as part of Ngo, Chung D., Ngo, Binh V., Hoang, Thuong T., Nguyen, Thi T.T. & Dang, Hai P., 2015, Feeding ecology of the common sun skink, Eutropis multifasciata (Reptilia: Squamata: Scincidae), in the plains of central Vietnam, pp. 2417-2436 in Journal of Natural History 49 (39) on page 2427, DOI: 10.1080/00222933.2015.1021876, http://zenodo.org/record/400016

Viral load testing to monitor the HIV epidemic among PWID in Vietnam

Objective: To share Vietnam’s experiences piloting the integration of viral load (VL) testing into the national HIV sentinel surveillance (HSS) system to better understand the level of HIV viral transmission among people who inject drugs (PWID).Introduction: Vietnam initiated the HSS system in 1994 in selected provinces with high HIV burden. The surveillance has two components: monitor HIV sero-prevalence and risk behaviors among key population including PWID. However, no VL data were collected among HIV infected people. In 2016, Vietnam piloted an added component of VL testing to the existing HSS system. The purpose was to test the feasibility of adding VL testing to the HSS so that VL data among PWID would be available. The pilot was conducted in two provinces in southern Vietnam-Ho Chi Minh City and Long An. It was expected that adding the VL testing to the existing HSS would also save resources and help monitor HIV viral transmission among PWID in the community regardless if they are currently on anti-retroviral therapy (ART).Methods: Male PWIDs were enrolled into 2016 HSS+ following the standard operating procedure (SOP)[1]. Community-based sampling was based on random selection of wards/communes listed in the sampling frame. In each selected ward/commune, all eligible PWID were invited to voluntarily participate in the survey. Eligibility criteria were males 16 years of age or older, reporting injecting drug in the past month, and residing in the selected area. . The survey included an interview using a standardized questionnaire and 7ml blood drawn for HIV testing. Blood specimens were transferred from districts to provincial labs for plasma separation in the same day. Each plasma specimen was divided into three aliquots of 1ml each. One aliquot was used to test for HIV diagnosis at provincial labs, using the national HIV testing strategy III[2]. The remaining 2 aliquots were stored at provincial labs at 2-80C and within 5 days, were shipped to Pasteur Institute in Ho Chi Minh City (PIHCM) where the plasma specimens were stored at -800C. Processing of samples for VL testing was conducted at the end of the survey where all plasma specimen were transferred to PIHCM lab, which was 2 months since the collection of the first blood specimen. VL was undertaken on COBAS AMPLYPREP/COBAS TAQMAN 48, with identification threshold 20 cps/ml and specificity of 100% using Kit CAP-G/CTM HIV-1 V 2.0. The VL testing results were sent back to relevant Provicial AIDS Centers to return to respective participants, within 3 months.Results: Five hundred male PWID (HCMC: 300; LA: 200) were enrolled into 2016 HSS/HSS+ and agreed to provide blood specimen without any refusal. 84 tested positive for HIV (16.8%. HCMC: 15.0%; LA: 19.5%), 43 (51.2%) specimens had unsuppressed VL (>1000 copies/ml) (HCMC: 66.7%; LA: 33.3%), 35 (41.7%) specimens had undetected level (<50 copies/ml or undetected) (HCMC: 31.1%; LA: 53.9%), and 7.1% had VL that ranged from 50-1000 copies/ml (HCMC: 2.2%; LA: 12.8%). Among those who had VL < 1000 copies/ml, 22 (53.7%) had ever been on ART.Conclusions: The pilot survey has measured VL among male PWID, including those who were aware of their HIV status and those who did not know their status before. Findings indicate that a significant proportion of PWID do not have their VL suppressed leading to high-risk of HIV transmission from PWID to their sexual partners[3] in the community although level of unsuppressed viral load is not a direct measure of HIV viral transmission in itself. This pilot indicated that it was feasible to add VL testing into HSS and Vietnam government can add it as a routine practice in HSS and can be expanded in the coming years

Spatial Analysis of Drug-Susceptible and Multidrug-Resistant Cases of Tuberculosis, Ho Chi Minh City, Vietnam, 2020–2023

We characterized the spatial distribution of drug-susceptible (DS) and multidrug-resistant (MDR) tuberculosis (TB) cases in Ho Chi Minh City, Vietnam, a major metropolis in southeastern Asia, and explored demographic and socioeconomic factors associated with local TB burden. Hot spots of DS and MDR TB incidence were observed in the central parts of Ho Chi Minh City, and substantial heterogeneity was observed across wards. Positive spatial autocorrelation was observed for both DS TB and MDR TB. Ward-level TB incidence was associated with HIV prevalence and the male proportion of the population. No ward-level demographic and socioeconomic indicators were associated with MDR TB case count relative to total TB case count. Our findings might inform spatially targeted TB control strategies and provide insights for generating hypotheses about the nature of the relationship between DS and MDR TB in Ho Chi Minh City and the wider southeastern region of Asia