Evaluating virological outcomes in people with HIV on stable antiretroviral therapy with reduced frequency of HIV viral load monitoring during the COVID-19 pandemic.

OBJECTIVES: In response to the COVID-19 pandemic, HIV outpatient attendances were restricted from March 2020, resulting in reduced frequency of HIV viral load (VL) monitoring (previously 6-monthly) in clinically stable and virologically suppressed people living with HIV (PLWH). We investigated virological outcomes during this period of reduced monitoring and compared with the previous year, prior to the COVID-19 pandemic. METHODS: People living with HIV with undetectable VL (<200 HIV RNA copies /mL) on antiretroviral therapy (ART) were identified from March 2018 to February 2019. We determined VL outcomes during the pre-COVD-19 period (March 2019-February 2020) and the COVID-19 period (March 2020-February 2021) when monitoring was restricted. Frequency and longest durations between VL tests in each period were evaluated, and virological sequelae in those with detectable VL were determined. RESULTS: Of 2677 PLWH virologically suppressed on ART (March 2018-February 2019), VLs were measured and undetectable in 2571 (96.0%) and 2003 (77.9%) in the pre-COVID and COVID periods, respectively. Mean (SD) numbers of VL tests were 2.3 (1.08) and 1.1 (0.83) and mean longest duration between VL tests was 29.5 weeks (SD 8.25, 3.1% were ≥12 months) and 43.7 weeks (12.64, 28.4% were ≥12 months), in the pre-COVID and COVID periods, respectively. Of 45 individuals with one or more detectable VL during the COVID-19 period, two developed new drug resistance mutations. CONCLUSION: Reduced VL monitoring was not associated with poorer virological outcomes in the majority of stable individuals receiving ART. One in 20 individuals had not returned for VL testing after ≥31 months and the risk of harm in these individuals is unknown.

Genome Scale Phylogenetic Analysis Differentiates SARS-CoV-2 Strains in Pakistani and Indian COVID-19 Patients with and without Travel History

The COVID-19 virus spread around the globe very rapidly during early 2020. Identification of the evolution pattern, and genome scale mutations in SARS-CoV-2 is essential to study the dynamics of this disease. The genomic sequences of thousands of SARS-CoV-2 infected patients from different countries are publicly available for sequence based in-depth analysis. In this study, the DNA sequences of SARS-CoV-2 from the COVID-19 infected patients (having or lacking a travel history) from Pakistan and India, the two highest populous neighboring countries in South Asia, have been analyzed by using computational tools of phylogenetics. These analyses revealed that the SARS-CoV-2 strain in Pakistani traveler COVID-19 patients is closely related to Iranian strains, the strain in non-traveler patients is related to the strain of Wuhan, China. Likewise, in India, the SARS-CoV-2 strains in travelers and non-travelers are closely related to Italy, Germany, and Mexico. The selected approach has also been utilized to find out the identical genomic regions and similar strains around the world. Collectively, our study suggested distinct strains and routes of viral transmission in Pakistan and India. These differences may infer partially the reason for the decline phase in viral propagation in Pakistan two months after the peak COVID-19 load, and rapid viral propagation in India making it the second worst-hit country in the world after the USA.

Mycoplasma genitalium identified in one-third of men with symptomatic non-gonococcal urethritis, with at least 40% of cases demonstrating macrolide resistance

Background: In recent years there has been increased awareness of Mycoplasma genitalium as a potential sexually-transmitted pathogen and national guidelines now recommend routine testing in a number of clinical scenarios in sexual health clinics, including non-gonococcal urethritis (NGU). Factors including availability and cost of resistance testing, quinolone-associated toxicities and a lack of available alternative treatments, all impact on the feasibility of routine testing. Knowledge of local prevalence and rates of drug resistance can inform the development of patient pathways and management strategies. The aim was to determine the prevalence of Mycoplasma genitalium in men with symptomatic NGU and the proportion of these infections that demonstrated macrolide resistance. Method: Routine testing for Mycoplasma genitalium in symptomatic NGU was introduced in August 2020, during a period when walk-in attendances were limited due to the COVID-19 pandemic. Testing was performed inhouse using the validated Roche Cobas® TV/MG PCR assay and positive samples were tested for the macrolide resistance gene using SpeeDx Resistanceplus® MG. Quinolone resistance testing was not routinely performed. Clinical information including patient demographics, treatments used, test of cure (TOC) results and coding data were reviewed and analysed. Results: 42 symptomatic men presented during August 2020 and were diagnosed with NGU. 34 (81%) had testing performed for Mycoplasma genitalium, 10/34 (29%) tests were positive. Resistance testing was performed on all positive samples, 4 (40%) were positive for macrolide resistance;2 (20%) were indeterminate and 4 (40%) were negative. All patients were treated with regimens according to BASHH guidelines and 1 (10%) patient had a positive TOC. Conclusion: High rates of Mycoplasma genitalium were identified when screening men with symptomatic urethritis in a central London sexual health clinic. In this population, at least 40% of infections had macrolide resistance demonstrated. The majority of individuals cleared the pathogen with symptom resolution and a negative TOC using recommended treatment regimens. Larger surveys in different populations will enhance knowledge of risk factors associated with Mycoplasma genitalium infection and antibiotic resistance. Further study of alternative treatment approaches for drug-resistant organisms are required.