Treatment outcomes 12 months after antiretroviral therapy initiation in Oman: a nationwide study from the Middle East.

ABSTRACTWe used routinely collected programme data on people living with HIV in Oman who started ART in 2014-2018 to assess retention on ART, viral suppression, attrition (mortality or loss to follow-up [LTFU]) and treatment failure (attrition or HIV viral load of > 1000 copies/mL) 12 months after antiretroviral therapy (ART) initiation. We identified 726 patients; 72% were male. Overall, 12 months retention on ART and viral suppression (intention-to-treat [ITT] analysis) were 85.7% and 74.5%, respectively. Attrition occurred in 14.3% (mortality of 7% and LTFU of 7.3%). Retention increased from 78.8% (93/118) to 90.6% (144/159) among patients who started ART in 2014 and 2018, respectively. Similarly, ITT and on-treatment analyses revealed that viral suppression 12 months after ART initiation increased from 57.6% (68/118) and 73.1% (68/93) among patients who initiated therapy in 2014-80.5% (128/159) and 88.8% (128/144) among patients started treatment in 2018, respectively. On multivariate analysis, older age, having "Other" as an HIV risk factor (compared to heterosexual) and receiving HIV care outside the capital Muscat independently predicted both attrition and treatment failure. Our findings have been useful in identifying factors at the individual and programme level that influenced the risk of attrition and treatment failure.

Disparities between HIV patient subgroups in Oman: An analysis of the 2019 cascade of care.

BACKGROUND: The HIV cascade of care is a framework for monitoring HIV care, identifying gaps and informing appropriate interventions. This study aimed to describe the cascade of care in Oman in 2019 and highlight disparities at the sub-population level. METHODS: We used the UNAIDS Spectrum modelling software to estimate the number of people living with HIV. A national HIV surveillance database was used to identify Omani people (≥13 years old) diagnosed with HIV from 1984 through December 2019. We calculated the cascade indicators as of 31 December 2019 stratified by sex, age, HIV risk factor, residence, and region of HIV care. We also performed multivariate logistic regression to determine the predictors of attrition at linkage, retention, on ART, and viral suppression. RESULTS: As of December 2019, the estimated number of people living with HIV in Oman was 2440. Out of the estimated number of people living with HIV, 69% were diagnosed, 66% were linked to care, 61% were retained in care, 60% were on ART, and 55% were virally suppressed. Of the 1673 diagnosed individuals, 96% were linked to care, 88% were retained in care, 87% were on ART, and 81% were virally suppressed. People who received HIV care outside Muscat had the largest attrition (11% loss) in the transition from linkage (97%) to retention (86%). Similarly, people aged 13-24 years had the largest attrition (13% loss) from "on ART" (88%) to viral suppression (75%). Logistic regression showed that both not reporting a specific HIV risk factor and receipt of HIV care outside Muscat independently predicted attrition at each cascade stage from linkage to care through viral suppression. CONCLUSIONS: Our findings identified substantial disparities across various subpopulations along the cascade of care in Oman. This analysis will be invaluable in informing future interventions targeting patient subgroups who are at the highest risk of attrition.

Relapse of herpes simplex encephalitis in a patient with metastatic small cell lung cancer following scalp sparing whole brain radiotherapy.

Herpes simplex virus is the most common cause of severe and potentially fatal sporadic encephalitis worldwide. Recurrence of neurologic symptoms after resolution of the initial episode of HSV encephalitis and despite adequate treatment with intravenous acyclovir is well recognized albeit rare. Most of these recurrences had no evidence of replicating virus and are immune in nature with only a minority of these recurrences representing true virologic relapses. Immunocompromised patients are predominantly at greater risk for virologic relapse of HSV encephalitis with potentially severe and at times fatal consequences. We describe a patient with small cell lung cancer and brain metastasis who underwent chemotherapy, treatment with dexamethasone and whole brain radiotherapy who subsequently suffered two episodes of HSV encephalitis three months and seven months after completion of radiotherapy and while on dexamethasone treatment.

Gastrointestinal basidiobolomycosis: Beware of the great masquerade a case report.

Basidiobolomycosis is rare infection caused by the saprophytic fungus Basidiobolus ranarum. Gastrointestinal basidiobolomycosis is an infrequent, albeit, increasingly reported, emerging form of the disease and typically affects immunocompetent individuals with potentially grave sequelae if unrecognized. Acquaintance with this exceptionally rare fungus and its potential for presenting as gastrointestinal mass masquerading as colonic malignancy is critical for timely diagnosis, appropriate treatment and successful clinical outcome. We report a case of gastrointestinal basidiobolomycosis masquerading as colonic malignancy in a 29-year-old Omani patient successfully treated with combination of surgery and prolonged azole antifungal therapy.

Immature development and adult eclosion of Ufens principalis Owen (Hymenoptera: Trichogrammatidae), an egg parasitoid of Homalodisca spp. (Hemiptera: Cicadellidae) in southern California.

The biology of the immature stages and adult eclosion of Ufens principalis Owen, an important parasitoid of Homalodisca eggs in southern California, were studied. The duration of the egg, larval and pupal stages at 26.7 degrees C were 0-1, 7 and 9 days, respectively. Sacciform larvae, which developed gregariously within host eggs, were motile until about five days of age, and then became sessile. Parasitized host eggs changed from whitish and soft when freshly-laid to yellow-orange and hard at five days and older. This change was accompanied by formation of septal walls separating the mature larvae and pupae. The rate of immature development had a strong positive linear relationship (R(2)=0.853, n=98) with temperatures in the range of 20.0-30.3 degrees C. The theoretical minimum threshold for immature development was 13.5 degrees C, and the required heat units were 241.0 degree-days. Adult eclosion from host eggs occurred mostly (85%) on the first two days of emergence. Although most females emerged during the morning hours (0600-1200 h), males tended to emerge earlier than females with equal emergence during the morning and late night hours (2400-0600 h). The rate of successful adult emergence was high (88%). The ratio of enclosed adults to the number of exit holes was 1.18, indicating that most adults tended to independently cut their exit holes. The number of exit holes had a strong negative relationship (R2=0.711, n=125) with exit hole size, suggesting that larger numbers of developing immatures per host egg result in an overall decrease in adult size.

Description and behavioural biology of two Ufens species (Hymenoptera: Trichogrammatidae), egg parasitoids of Homalodisca species (Hemiptera: Cicadellidae) in southern California.

The morphology, distribution, and hosts of two egg parasitoids, Ufens principalis Owen sp. n. and U. ceratus Owen sp. n. (Hymenoptera: Trichogrammatidae), are described for the first time. These species are compared to U. niger (Ashmead), the only species of Ufens s. str. currently described from the Nearctic, and diagnostic differences are presented. The behavioural biology of U. principalis, and U. ceratus to a smaller extent, is also described for the first time. Ufens principalis exhibited a rapid and long-distance response in the form of directional flight toward freshly laid eggs of Homalodisca species, its primary hosts in southern California. Parasitism involved aggregations of female U. principalis on fresh Homalodisca egg masses, which remained attractive to U. principalis for a relatively short time. The level of oviposition by U. principalis females was low during most of the day and peaked before sunset in tandem with a peak in Homalodisca oviposition. Oviposition behaviour of U. principalis is described and the distribution of ovipositor probe durations showed that most probes were generally of very short duration. Mating of both Ufens species occurred on the egg mass, with males showing aggressive behaviour towards each other as they competed for emerging females. Ufens ceratus males displayed greater aggression towards other males than U. principalis males. By contrast, fights among U. principalis males involved more individuals and lasted longer than corresponding fights between U. ceratus males.