Trichosporon asahii Urinary Tract Infection in a Patient with Severe COVID-19.

Trichosporon asahii is a yeast-like basidiomycete that is an emerging opportunistic infection in immunocompromised patients. Urinary tract infections due to T. asahii are rarely reported in the literature and typically seen only in immunocompromised patients. In addition to being immunocompromised, critically ill COVID-19 patients often have prolonged exposure to antibiotics, corticosteroids, and Foley catheters, which further increases their susceptibility to infection with T. asahii. There are limited case reports documenting successful treatment of T. asahii among hospitalized patients, particularly among COVID-19 patients, in the literature. Therefore, it is important that successful treatment regimens be reported. Here, we report a case of T. asahii urinary tract infection successfully treated with fluconazole and voriconazole in a 73-year-old male recovering from COVID-19. Urinary tract infections with T. asahii should be considered in persistently febrile COVID-19 patients with fungal urinary tract infections since prompt recognition and treatment can reduce the risk of disseminated disease and early mortality.

A Retrospective Assessment of Antecedent Pre-Exposure Prophylaxis Eligibility of HIV-Positive Women in the South.

African American women disproportionately endure the predominance of HIV infections among women, especially in the South. HIV pre-exposure prophylaxis (PrEP) is recognized as an effective prevention strategy for individuals at higher risk of HIV acquisition. Accordingly, PrEP is recommended in heterosexually active adult persons who are HIV negative; not in a monogamous relationship with an HIV-negative partner; and infrequently use condoms with a partner who is a bisexual male, HIV positive, or uses recreational intravenous (IV) drugs. Despite PrEP's acceptance among other groups at higher risk of HIV acquisition, studies indicate low use among African American women in the South. It is unclear whether underutilization results from a low perceived risk of HIV infection or from miscalculation of risk by clinicians. To ascertain the fitness of current PrEP indicators to evaluate HIV acquisition risk in heterosexual women, 102 HIV-positive women in Atlanta, GA, were queried about their awareness of and participation in higher risk heterosexual relationship dynamics before their HIV diagnosis. Risk awareness and behaviors were retrospectively assessed to determine whether the same women, now HIV positive, would have been considered for PrEP before their HIV diagnoses. When queried, 66% reported having only one sexual partner, 64% reported having sex ≥4 times with the partner from whom they acquired HIV, and >90% reported no knowledge of their partners' HIV-positive status or bisexual orientation. As demonstrated, heterosexual women with only one sexual partner and limited awareness of their partners' HIV-positive status or bisexual orientation remain at substantial risk of HIV acquisition without suitable risk approximation strategies.

Retention strategies and factors associated with missed visits among low income women at increased risk of HIV acquisition in the US (HPTN 064).

Women at high-risk for HIV acquisition often face challenges that hinder their retention in HIV prevention trials. These same challenges may contribute to missed clinical care visits among HIV-infected women. This article, informed by the Gelberg-Andersen Behavioral Model for Vulnerable Populations, identifies factors associated with missed study visits and describes the multifaceted retention strategies used by study sites. HPTN 064 was a multisite, longitudinal HIV seroincidence study in 10 US communities. Eligible women were aged 18-44 years, resided in a census tract/zipcode with high poverty and HIV prevalence, and self-reported ≥1 personal or sex partner behavior related to HIV acquisition. Multivariate analyses of predisposing (e.g., substance use) and enabling (e.g., unmet health care needs) characteristics, and study attributes (i.e., recruitment venue, time of enrollment) identified factors associated with missed study visits. Retention strategies included: community engagement; interpersonal relationship building; reduction of external barriers; staff capacity building; and external tracing. Visit completion was 93% and 94% at 6 and 12 months. Unstable housing and later date of enrollment were associated with increased likelihood of missed study visits. Black race, recruitment from an outdoor venue, and financial responsibility for children were associated with greater likelihood of attendance. Multifaceted retention strategies may reduce missed study visits. Knowledge of factors associated with missed visits may help to focus efforts.