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Kettunen P, Koistinaho J, Rolova T. Contribution of CNS and extra-CNS infections to neurodegeneration: a narrative review. J Neuroinflammation 2024; 21:152. [PMID: 38845026 PMCID: PMC11157808 DOI: 10.1186/s12974-024-03139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Central nervous system infections have been suggested as a possible cause for neurodegenerative diseases, particularly sporadic cases. They trigger neuroinflammation which is considered integrally involved in neurodegenerative processes. In this review, we will look at data linking a variety of viral, bacterial, fungal, and protozoan infections to Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis and unspecified dementia. This narrative review aims to bring together a broad range of data currently supporting the involvement of central nervous system infections in the development of neurodegenerative diseases. The idea that no single pathogen or pathogen group is responsible for neurodegenerative diseases will be discussed. Instead, we suggest that a wide range of susceptibility factors may make individuals differentially vulnerable to different infectious pathogens and subsequent pathologies.
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Affiliation(s)
- Pinja Kettunen
- Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Jari Koistinaho
- Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.
| | - Taisia Rolova
- Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
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2
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Stover J, Glaubius R. Methods and Assumptions for Estimating Key HIV Indicators in the UNAIDS Annual Estimates Process. J Acquir Immune Defic Syndr 2024; 95:e5-e12. [PMID: 38180735 PMCID: PMC10769177 DOI: 10.1097/qai.0000000000003316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/07/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Each year UNAIDS supports national teams to estimate key HIV indicators using their latest data. These estimates are produced using a collection of models and software tools. This paper describes the demographic and HIV projection models used in this process. METHODS The demographic model (DemProj) projects the population by sex and single age for each year of the estimate. This information is fed into the HIV model (AIDS Impact Model) to estimate key HIV indicators. The model uses program, survey and surveillance data along with incidence trends produced through 1 of several separate models, to estimate new HIV infections, HIV-related deaths, and the population living with HIV by sex, age, CD4 category, and treatment status. RESULTS These models allow the annual production of estimates of key HIV indicators including uncertainty intervals. This information is used to track progress toward national and global goals and to develop national strategic plans, Global Fund applications and PEPFAR country operational plans. CONCLUSIONS Under the guidance of the UNAIDS Reference Group on Estimates, Modeling and Projections, these models are updated on a regular basis in response to evolving programmatic needs, new data, and analyses. This process of continuous review and improvement has led to mature models that make the best use of available data to provide estimates of indicators important to monitoring progress and developing future plans.
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Affiliation(s)
- John Stover
- Center for Modeling and Analysis, Avenir Health, Glastonbury, CT
| | - Robert Glaubius
- Center for Modeling and Analysis, Avenir Health, Glastonbury, CT
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3
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Bigio J, Aho J, Chittle A, Cox J. Improving access to test results for participants in bio-behavioural surveys of people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104192. [PMID: 37690921 DOI: 10.1016/j.drugpo.2023.104192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
Bio-behavioural surveys of people who inject drugs (PWID) evolved from unlinked anonymous monitoring (UAM) of human immunodeficiency virus (HIV) incidence and prevalence, which began in some high-income countries in the late 1980s. UAM was conducted purely for surveillance purposes and test results were not returned to participants. Later, the importance of collecting data on behavioural risk factors was recognised, leading to the development of bio-behavioural surveys of PWID, which today are conducted regularly in several countries. Typically, these surveys recruit participants from venues providing harm reduction services and involve behavioural questionnaires and dried blood spot (DBS) testing for HIV and hepatitis C (HCV). DBS test results are not returned to participants; instead, countries offer varied systems of on-site testing separate from the bio-behavioural testing or provide referrals to external testing services. In this commentary, we trace the history of bio-behavioural surveys of PWID from their origins to the present day to explain how the methodologies evolved, along with the ethical considerations underlying them. We highlight the dramatic improvements in treatments for HIV and HCV over the past thirty years and the corresponding need to ensure that bio-behavioural survey participants can access low-barrier and timely testing. We review the pros and cons of different strategies for providing test results to participants and argue that the return of DBS results collected as part of bio-behavioural surveys warrants consideration as an additional tool to improve testing access for participants. Any changes should be informed by the perspectives of participants, study site personnel and investigators.
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Affiliation(s)
- Jacob Bigio
- Sexually Transmitted and Blood-Borne Infections Surveillance Division, Public Health Agency of Canada, Montreal, QC, Canada
| | - Josephine Aho
- Sexually Transmitted and Blood-Borne Infections Surveillance Division, Public Health Agency of Canada, Montreal, QC, Canada
| | - Andrea Chittle
- Sexually Transmitted and Blood-Borne Infections Surveillance Division, Public Health Agency of Canada, Montreal, QC, Canada
| | - Joseph Cox
- Sexually Transmitted and Blood-Borne Infections Surveillance Division, Public Health Agency of Canada, Montreal, QC, Canada.
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Getaneh Y, Getnet F, Ning F, Rashid A, Liao L, Yi F, Shao Y. HIV-1 Disease Progression and Drug Resistance Mutations among Children on First-Line Antiretroviral Therapy in Ethiopia. Biomedicines 2023; 11:2293. [PMID: 37626789 PMCID: PMC10452141 DOI: 10.3390/biomedicines11082293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Background: High rates of disease progression and HIV drug resistance (HIVDR) among adults taking highly active antiretroviral treatment (HAART) in Sub-Saharan Africa were previously documented. However, children were generally not considered despite their greater risk. Hence, this study was aimed to evaluate HIV-1 disease progression and drug resistance mutation among children on first-line antiretroviral therapy in Ethiopia. Method: A longitudinal study was conducted among 551 HIV-positive children (<15 years old) recruited between 2017 and 2019 at 40 antiretroviral treatment delivery sites in Ethiopia. Disease progression was retrospectively measured over a 12-year (2007-2019) follow-up as the progress towards immunosuppression. Two consecutive viral load (VL) tests were conducted in 6-month intervals to assess virologic failure (VF). For children with VF, HIV-1 genotyping and sequencing was performed for the pol gene region using in-house assay validated at the Chinese Center for Disease Control and Prevention, and the Stanford HIVDB v9.0 algorithm was used for identification of drug resistance mutations. The Kaplan-Meier analysis and Cox proportional hazards regression model were used to estimate the rate and predictors of disease progression, respectively. Results: The disease progression rate was 6.3 per 100 person-years-observation (95% CI = 4.21-8.53). Overall immunosuppression (CD4 count < 200 cells/mm3) during the 12-year follow-up was 11.3% (95% CI = 7.5-15.1). Immunosuppression was significantly increased as of the mean duration of 10.5 (95% CI = 10.1-10.8) years (38.2%) to 67.8% at 12 years (p < 0.001). Overall, 14.5% had resistance to at least one drug, and 6.2% had multi-drug resistance. A resistance of 67.8% was observed among children with VF. Resistance to non-nucleotide reverse transcriptase inhibitors (NNRTI) and nucleotide reverse transcriptase inhibitors (NRTI) drugs were 11.4% and 10.1%, respectively. Mutations responsible for NRTI resistance were M184V (30.1%), K65R (12.1%), and D67N (5.6%). Moreover, NNRTI-associated mutations were K103N (14.8%), Y181C (11.8%), and G190A (7.7%). Children who had a history of opportunistic infection [AHR (95% CI) = 3.4 (1.8-6.2)], vitamin D < 20 ng/mL [AHR (95% CI) = 4.5 (2.1-9.9)], drug resistance [AHR (95% CI) = 2.2 (1.4-3.6)], and VF [AHR (95% CI) = 2.82 (1.21, 3.53)] had a higher hazard of disease progression; whereas, being orphan [AOR (95% CI) = 1.8 (1.2-3.1)], history of drug substitution [(AOR (95% CI) = 4.8 (2.1-6.5), hemoglobin < 12 mg/dL [AOR (95% CI) = 1.2 (1.1-2.1)] had higher odds of developing drug resistance. Conclusions: Immunosuppression was increasing over time and drug resistance was also substantially high. Enhancing routine monitoring of viral load and HIVDR and providing a vitamin-D supplement during clinical management could help improve the immunologic outcome. Limiting HAART substitution is also crucial for children taking HAART in Ethiopia.
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Affiliation(s)
- Yimam Getaneh
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310027, China;
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
| | - Fentabil Getnet
- Ethiopian Public Health Institute, Addis Ababa P.O. Box 1242, Ethiopia
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Feng Ning
- Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Abdur Rashid
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Lingjie Liao
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Feng Yi
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Yiming Shao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310027, China;
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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Birhanu S, Winterhalter FS, Stupp P, Cates M, Rottinghaus E, Yavo D, Wray-Gordon F, Lupoli K, Ndongmo CB, Longwe H, Reid GA, Metz M, Saito S, McCracken S, Brown K, Voetsch AC, Duong YT, Parekh BS, Patel HK. Point of Care CD4 Testing in National Household Surveys - Results and Quality Indicators from Eleven Population-Based HIV Impact Assessment (PHIA) Surveys. Microbiol Spectr 2023; 11:e0314822. [PMID: 37071009 PMCID: PMC10269725 DOI: 10.1128/spectrum.03148-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/13/2023] [Indexed: 04/19/2023] Open
Abstract
Population-based HIV Impact Assessments (PHIAs) are national household (HH) surveys that provide HIV diagnosis and CD4 testing with an immediate return of results. Accurate CD4 results improve HIV-positive participants' clinical care and inform the effectiveness of HIV programs. Here, we present CD4 results from the PHIA surveys that were conducted in 11 countries in sub-Saharan Africa between 2015 and 2018. All of the HIV-positive participants and 2 to 5% of the HIV-negative participants were offered Pima CD4 (Abbott, IL, USA) point-of-care (POC) tests. The quality of the CD4 test was ensured by conducting instrument verification, comprehensive training, quality control, a review of testing errors and an analysis of unweighted CD4 data by HIV status, age, gender, and antiretroviral (ARV) treatment status. Overall, CD4 testing was completed for 23,085 (99.5%) of the 23,209 HIV-positive and 7,329 (2.7%) of the 270,741 negative participants in 11 surveys. The instrument error rate was 11.3% (range, 4.4% to 15.7%). The median CD4 values among HIV-positive and HIV-negative participants (aged 15+) were 468 cells/mm3 (interquartile range [IQR], 307 to 654) and 811 cells/mm3 (IQR, 647 to 1,013), respectively. Among the HIV-positive participants (aged 15+), those with detectable ARVs had higher CD4 values (508 cells/mm3) than those with undetectable ARVs (385.5 cells/mm3). Among the HIV-positive participants (aged 15+), 11.4% (2,528/22,253) had a CD4 value of less than 200 cells/mm3, and approximately half of them (1,225/2,528 = 48.5%) had detectable ARVs, whereas 51.5% (1,303/2,528) had no detectable ARVs (P < 0.0001). We successfully implemented high quality POC CD4 testing using Pima instruments. Our data come from nationally representative surveys in 11 countries and provide unique insights regarding the CD4 distribution among HIV-positive individuals as well as the baseline CD4 values among HIV-negative individuals. IMPORTANCE The manuscript describes CD4 levels among HIV-positive individuals and baseline CD4 levels among HIV-negative individuals from 11 sub-Saharan countries, thereby highlighting the importance of CD4 markers in the context of the HIV epidemic. Despite increased ARV access in each country, advanced HIV disease (CD4 < 200 cells/mm3) persists among approximately 11% of HIV-positive individuals. Therefore, it is important that our findings are shared with the scientific community to assist with similar implementations of point-of-care testing and to conduct a review of HIV programmatic gaps.
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Affiliation(s)
- Sehin Birhanu
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | | | - Paul Stupp
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Melissa Cates
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Erin Rottinghaus
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Daniel Yavo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Floris Wray-Gordon
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Kathryn Lupoli
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Clement B. Ndongmo
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | | | - Giles A. Reid
- ICAP at Columbia University, New York, New York, USA
| | - Melissa Metz
- ICAP at Columbia University, New York, New York, USA
| | - Suzue Saito
- ICAP at Columbia University, New York, New York, USA
| | - Stephen McCracken
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Kristin Brown
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Andrew C. Voetsch
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Yen T. Duong
- ICAP at Columbia University, New York, New York, USA
| | - Bharat S. Parekh
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
| | - Hetal K. Patel
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia, USA
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6
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Dodd PJ, Shaweno D, Ku CC, Glaziou P, Pretorius C, Hayes RJ, MacPherson P, Cohen T, Ayles H. Transmission modeling to infer tuberculosis incidence prevalence and mortality in settings with generalized HIV epidemics. Nat Commun 2023; 14:1639. [PMID: 36964130 PMCID: PMC10037365 DOI: 10.1038/s41467-023-37314-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
Tuberculosis (TB) killed more people globally than any other single pathogen over the past decade. Where surveillance is weak, estimating TB burden estimates uses modeling. In many African countries, increases in HIV prevalence and antiretroviral therapy have driven dynamic TB epidemics, complicating estimation of burden, trends, and potential intervention impact. We therefore develop a novel age-structured TB transmission model incorporating evolving demographic, HIV and antiretroviral therapy effects, and calibrate to TB prevalence and notification data from 12 African countries. We use Bayesian methods to include uncertainty for all TB model parameters, and estimate age-specific annual risks of TB infection, finding up to 16.0%/year in adults, and the proportion of TB incidence from recent (re)infection, finding a mean across countries of 34%. Rapid reduction of the unacceptably high burden of TB in high HIV prevalence settings will require interventions addressing progression as well as transmission.
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Affiliation(s)
- Peter J Dodd
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Debebe Shaweno
- School of Public Health, Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Chu-Chang Ku
- School of Public Health, Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Philippe Glaziou
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | - Richard J Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter MacPherson
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ted Cohen
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Helen Ayles
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia
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Maheu‐Giroux M, Ciaranello AL, Salomon JA, Sohn AH. Refining global HIV estimates for decision-making: advances in analytic and modelling methods used by the Joint United Nations Programme on HIV/AIDS. J Int AIDS Soc 2021; 24 Suppl 5:e25790. [PMID: 34546663 PMCID: PMC8454484 DOI: 10.1002/jia2.25790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mathieu Maheu‐Giroux
- Department of Epidemiology and BiostatisticsSchool of Population and Global HealthMcGill UniversityMontréalQuébecCanada
| | - Andrea L. Ciaranello
- Division of Infectious Diseases and Medical Practice Evaluation CenterMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Joshua A. Salomon
- Center for Health PolicyCenter for Primary Care & Outcomes ResearchSchool of MedicineFreeman Spogli Institute for International StudiesStanford UniversityStanfordCaliforniaUSA
| | - Annette H. Sohn
- TREAT Asia/amfAR – The Foundation for AIDS ResearchBangkokThailand
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