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Gastroenterology ; 162(7):S-1008, 2022.
Article in English | EMBASE | ID: covidwho-1967396


BACKGROUND: Immune-modulating medications for inflammatory bowel diseases (IBD) have been associated with suboptimal vaccine responses. There is conflicting data with SARS-CoV-2 vaccination. METHODS: We measured SARS-CoV-2 vaccine immunogenicity at 2 weeks post 2nd mRNA vaccine in IBD patients as compared to normal healthy donors (NHD). We measured humoral immune responses to SARS-CoV-2: anti-spike Immunoglobulin G (IgG) and anti-receptor binding domain (RBD) IgG were measured by ELISA, and neutralizing antibody titers were measured using recombinant, reporter SARS-CoV-2. Antigen specific memory B cells were measured using recombinant SARS-CoV-2 proteins. Activation induced marker T cell (AIM) assays were performed using SARS-CoV-2 spike megapools. Immunophenotyping was performed by flow cytometry. RESULTS: We enrolled 29 patients with IBD (19 with Crohn's disease, 10 with ulcerative colitis) on infliximab (IFX) monotherapy (N=9), IFX combination therapy with a thiopurine (N=9), vedolizumab monotherapy (N= 11) as compared to matched NHD (N=12). At 2 weeks post vaccination, all subjects made detectable anti-spike IgG and anti-RBD IgG. There were no differences in anti-spike IgG titers among the different groups. IBD patients on IFX monotherapy, but not IBD patients on IFX combination therapy or vedolizumab monotherapy, had lower anti-RBD and neutralization titers as compared to NHD (p-value: 0.041 and 0.023, respectively) (Fig. 1). There were no significant differences in the percentage of spike-specific or RBD-specific memory B cells in IBD patients as compared to NHD (Fig. 1). There were no differences in the percentage of spike-specific CD4+ or CD8+ T cells in all IBD patients as compared to NHDs (Fig. 2). CONCLUSIONS: We demonstrate overall comparable and perserved cell-mediated immunity to SARS-CoV-2 vaccination in a small cohort of IBD patients treated with a range of different immune-modulating medications as compared to healthy controls. Larger numbers of patients are needed to validate these findings.

International Journal of Antimicrobial Agents ; 58:39-40, 2021.
Article in English | Web of Science | ID: covidwho-1695527
Journal of the American Society of Nephrology ; 32:83-84, 2021.
Article in English | EMBASE | ID: covidwho-1490101


Background: Although COVID-19 is impacting all communities, the distribution of its harms is not equal. Poor, urban people of color with compromised health are particularly hard-hit. This study explores how patients with end-stage kidney disease (ESKD), living in underprivileged urban communities, manage their illness and treatment experiences and disease-associated stigmas in the face of COVID-19. Methods: We used purposive sampling to enroll patients with ESKD at a safety net hospital in Boston, MA. 12 remote ethnographic interviews were conducted from December 2020 to June 2021. Interviews were recorded and transcribed, and data were analyzed using grounded theory and dimensional narrative analysis. We identified dominant themes reflecting the biosocial harms caused by ESKD as well as patients' sense of isolation and stigmatization before and during the COVID-19 pandemic. Results: The mean age of patients was 56±14 years, 50% were female, and 90% selfidentified as Black. Almost all patients reported adverse effects from dialysis treatment which leaves them depleted and precludes them from working. Facing the biosocial implications of dialysis, patients also experienced severe economic hardship which has been intensified by the COVID-19 pandemic. While many patients framed COVID-19 as just one more thing and denied increased stigmatization by others due to their potentially increased susceptibility to infection, male patients more frequently reported experiencing racial stigmatization and narrated it as contributing to and exacerbating their chronic illness and suffering. Conclusions: Biosocial and environmental factors as well as institutional racism and stigmatization play significant roles in amplifying the burden of ESKD in patients of color who are now syndemically impacted by COVID-19 (Figure 1). A better understanding of how these factors interplay will help to inform policy makers in alleviating tensions and structural conditions that impinge on patients' well-being and health outcomes.

International Journal of Antimicrobial Agents ; 58, 2021.
Article in English | Scopus | ID: covidwho-1442389