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1.
Clin Infect Dis ; 75(1): e289-e292, 2022 08 24.
Article in English | MEDLINE | ID: mdl-35353885

ABSTRACT

We report a 23% asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) Omicron carriage rate in participants being enrolled into a clinical trial in South Africa, 15-fold higher than in trials before Omicron. We also found lower CD4 + T-cell counts in persons with human immunodeficiency virus (HIV) strongly correlated with increased odds of being SARS-CoV-2 polymerase chain reaction (PCR) positive.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , Polymerase Chain Reaction , South Africa/epidemiology
2.
medRxiv ; 2022 Jan 14.
Article in English | MEDLINE | ID: mdl-35043118

ABSTRACT

The early widespread dissemination of Omicron indicates the urgent need to better understand the transmission dynamics of this variant, including asymptomatic spread among immunocompetent and immunosuppressed populations. In early December 2021, the Ubuntu clinical trial, designed to evaluate efficacy of the mRNA-1273 vaccine (Moderna) among persons living with HIV (PLWH), began enrolling participants. Nasal swabs are routinely obtained at the initial vaccination visit, which requires participants to be clinically well to receive their initial jab. Of the initial 230 participants enrolled between December 2 and December 17, 2021, 71 (31%) were PCR positive for SARS-CoV-2: all of whom were subsequently confirmed by S gene dropout to be Omicron; 48% of the tested samples had cycle threshold (CT) values <25 and 18% less than 20, indicative of high titers of asymptomatic shedding. Asymptomatic carriage rates were similar in SARS-CoV-2 seropositive and seronegative persons (27% respectively). These data are in stark contrast to COVID-19 vaccine studies conducted pre-Omicron, where the SARS-CoV-2 PCR positivity rate at the first vaccination visit ranged from <1%-2.4%, including a cohort of over 1,200 PLWH largely enrolled in South Africa during the Beta outbreak. We also evaluated asymptomatic carriage in a sub study of the Sisonke vaccine trial conducted in South African health care workers, which indicated 2.6% asymptomatic carriage during the Beta and Delta outbreaks and subsequently rose to 16% in both PLWH and PHLWH during the Omicron period.

3.
Clin Infect Dis ; 58(9): 1333-7, 2014 May.
Article in English | MEDLINE | ID: mdl-24550373

ABSTRACT

We compared primary Epstein-Barr virus (EBV) infection and suppression between Kenyan human immunodeficiency virus-infected infants starting nevirapine-based vs lopinavir/ritonavir-based antiretroviral regimens. Although the rate of EBV infection was similar between groups, infants receiving lopinavir/ritonavir suppressed EBV more rapidly. Our findings suggest that specific antiretrovirals may potentially impact the risk of future EBV-associated malignancies.


Subject(s)
Anti-HIV Agents/therapeutic use , Epstein-Barr Virus Infections/prevention & control , HIV Infections/drug therapy , Nevirapine/therapeutic use , Ritonavir/therapeutic use , Drug Therapy, Combination , HIV Infections/complications , Humans , Infant , Kenya , Lopinavir , Risk Factors
4.
J Clin Virol ; 58(1): 276-8, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23827788

ABSTRACT

BACKGROUND: Additional drugs are needed for the treatment of cytomegalovirus (CMV) infection. Artesunate is an antimalarial drug that has activity against CMV in vitro and in a rodent model. Only a small number of case reports are available describing the clinical effects of artesunate on CMV infection, and these yielded inconsistent results. OBJECTIVE: To evaluate the effect of artesunate on CMV infection, using blood samples collected from children who participated in malaria treatment trials. STUDY DESIGN: Quantitative CMV DNA PCR was performed on dried blood spots collected from 494 Ugandan children, who were randomized either to artesunate plus amodiaquine or sulfadoxine-pyrimethamine plus amodiaquine for acute malaria infection. Poisson regression was used to compare treatment regimens with respect to the change in the frequency and quantity of CMV detected that occurred before and after treatment. RESULTS: CMV was detected in 11.4% of children immediately prior to treatment and 10.7% 3 days later (p=0.70). The average quantity of CMV was 0.30 log10 copies per million cells higher on day 3 than at treatment initiation (95% CI 0.01-0.58, p=0.041). There was no measurable difference in either the frequency or quantity of CMV detected in blood between children randomized to the two treatment arms. CONCLUSIONS: A standard 3-day artesunate-containing antimalarial regimen had no detectable effect on CMV viremia in children with malaria. Longer treatment courses and/or higher doses of artesunate than those routinely used for malaria may be required for effective treatment of CMV infection.


Subject(s)
Antimalarials/therapeutic use , Antiviral Agents/therapeutic use , Artemisinins/therapeutic use , Cytomegalovirus Infections/drug therapy , Cytomegalovirus/isolation & purification , Viremia/drug therapy , Adolescent , Artesunate , Child , Child, Preschool , DNA, Viral/blood , Drug Therapy, Combination/methods , Female , Humans , Infant , Malaria/complications , Malaria/drug therapy , Male , Real-Time Polymerase Chain Reaction , Treatment Outcome , Uganda
5.
J Med Virol ; 85(9): 1602-10, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23852686

ABSTRACT

Risk of Kaposi sarcoma (KS) is linked to detection of Kaposi sarcoma-associated herpesvirus (KSHV) DNA in plasma, but little is known about the prevalence and risk factors for plasma KSHV DNA detection among the general population where KS is endemic. Correlates of KSHV plasma detection were investigated in a population-based sample of adult Ugandans (15-59 years) who participated in an HIV/AIDS serobehavioral survey in 2004/2005. KSHV DNA was measured in plasma of 1,080 KSHV seropositive and 356 KSHV seronegative persons using polymerase chain reaction (PCR). KSHV DNA in plasma was detected in 157 (8.7%) persons; of these 149 (95%) were KSHV seropositive and 8 (5%) were seronegative. Detection of KSHV DNA in plasma was significantly associated with male sex (P < 0.001), older age (P = 0.003), residence in a rural versus urban area (P = 0.002), geographic region (P = 0.02), and being KSHV seropositive (13.8% seropositive vs. 2.3% seronegative, P < 0.001). In a multivariable model, KSHV DNA plasma quantity was significantly higher in men (P = 0.002), inversely associated with age (P = 0.05), and residing in an urban area (P = 0.01). In Uganda, KSHV is detected more frequently in the plasma of adult males and residents of rural regions, potentially explaining the increased risk of KS in these subsets of the Ugandan population.


Subject(s)
Herpesviridae Infections/epidemiology , Herpesvirus 8, Human/classification , Herpesvirus 8, Human/isolation & purification , Viremia/epidemiology , Adolescent , Adult , DNA, Viral/blood , Female , HIV Infections/complications , Herpesviridae Infections/virology , Herpesvirus 8, Human/genetics , Humans , Male , Middle Aged , Plasma/virology , Prevalence , Risk Factors , Uganda/epidemiology , Viral Load , Viremia/virology , Young Adult
6.
J Infect Dis ; 207(12): 1798-806, 2013 Jun 15.
Article in English | MEDLINE | ID: mdl-23493724

ABSTRACT

BACKGROUND: Human immunodeficiency virus (HIV) infection is a risk factor for Epstein-Barr virus (EBV)-associated lymphomas. Characterizing primary infection may elucidate risk factors for malignancy. METHODS: To describe clinical and virologic manifestations of primary EBV infection among infants born to HIV-infected women, specimens were utilized from a cohort study conducted in Nairobi, Kenya. HIV and EBV viral loads were measured serially in plasma. EBV serology was performed on EBV DNA-negative infants. Monthly clinical examinations were performed by pediatricians. RESULTS: The probability of EBV infection by 1 year of age was .78 (95% CI, .67-.88) in HIV-infected and .49 (95% CI, .35-.65) in HIV-uninfected infants (P < .0001). At 2 years, probability of EBV infection was .96 (95% CI, .89-.99) in HIV-infected infants. Peak EBV loads were higher in HIV-infected versus HIV-uninfected infants (median 2.6 vs 2.1 log10 copies/mL; P < .0001). The majority of HIV-infected infants had detectable EBV DNA for >3 months (79%). Primary EBV infection was associated with cough, fever, otitis media, pneumonia, hepatomegaly, splenomegaly, and hospitalization in HIV-infected infants; conjunctivitis and rhinorrhea in HIV-uninfected infants. CONCLUSIONS: EBV infection occurs early in infants born to HIV-infected women. HIV infection was associated with more frequent and higher quantity EBV DNA detection.


Subject(s)
Epstein-Barr Virus Infections/epidemiology , Epstein-Barr Virus Infections/transmission , HIV Infections/complications , Herpesvirus 4, Human/isolation & purification , Infectious Disease Transmission, Vertical , Adult , Antibodies, Viral/blood , Cohort Studies , DNA, Viral/blood , Epstein-Barr Virus Infections/complications , Epstein-Barr Virus Infections/virology , Female , HIV Infections/transmission , HIV Infections/virology , Herpesvirus 4, Human/genetics , Herpesvirus 4, Human/immunology , Humans , Incidence , Infant , Kenya/epidemiology , Longitudinal Studies , Male , Risk Factors , Viral Load , Viremia , Young Adult
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