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Bakri FG, Mukattash HH, Esmeiran H, Schluck G, Storme CK, Broach E, Mebrahtu T, Alhawarat M, Valencia-Ruiz A, M'Hamdi O, Malia JA, Hassen Z, Shafei MMS, Alkhatib AY, Gazo M, Jaradat SA, Gomez Y, McGeehon S, McCauley MD, Moreland SC, Darden JM, Amare M, Crowell TA, Vasan S, Michael NL, Ake JA, Modjarrad K, Scott PT, Peel SA, Hakre S. Clinical, molecular, and drug resistance epidemiology of HIV in Jordan, 2019-2021: a national study. Int J Infect Dis 2024:107079. [PMID: 38697607 DOI: 10.1016/j.ijid.2024.107079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/01/2024] [Accepted: 04/28/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Limited epidemiologic studies have been conducted in Jordan describing the HIV epidemic. This study aimed to address this gap to inform HIV prevention and control. METHODS A nationally-representative cross-sectional study was conducted among adults living with HIV in Jordan. Laboratory testing included HIV viral load and next-generation-sequencing-based clinical genotype. Log-binomial regression estimated risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS Among 231 (70%) participants, most were male (184/80%), and from Jordan (217/94%). Among 188 treatment-experienced-participants (>6 months), 165 (88%) were virally suppressed. High level resistance was most frequent against nucleoside reverse transcriptase inhibitor (13/81%), and integrase-strand transfer inhibitor (INSTI) (10/62%) drugs among viremic (≥1,000 HIV copies/mL) treatment-experienced participants with drug resistant mutations (DRMs, n=16). Common HIV subtypes (n=43) were B (6/14%), A1 (5/12%), and CRF01_AE (5/12%); additionally, novel recombinant forms were detected. In multivariate analysis, independently higher risk for late diagnosis (n=49) was observed with diagnosis through blood donation (vs check-up: RR 2·20, 95%CI 1·16-4·17) and earlier time-period of diagnosis (1986-2014 vs 2015-2021: RR 2·87, 95%CI 1·46-5·62). CONCLUSIONS Late diagnosis and INSTI resistance endanger national HIV prevention and treatment in Jordan - high-level resistance to INSTI suggests therapeutic drug monitoring is needed for treatment efficacy, and conservation of treatment options.
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Affiliation(s)
- Faris G Bakri
- Division of Infectious Diseases, Department of Internal Medicine, Jordan University Hospital, P. O. Box 13046, Amman 11942, Jordan; Infectious Diseases and Vaccine Center, University of Jordan, Queen Rania Street, Amman, Jordan
| | - Heyam H Mukattash
- Primary Health Care Directorate, Jordan Ministry of Health, Prince Hamzah Street, Amman, Jordan
| | - Hiam Esmeiran
- HJF Medical Research International (HJFMRI), King Abdullah II Street, Amman, Jordan
| | - Glenna Schluck
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, Maryland 20817, United States of America
| | - Casey K Storme
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, Maryland 20817, United States of America
| | - Erica Broach
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, Maryland 20817, United States of America
| | - Tsedal Mebrahtu
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, Maryland 20817, United States of America
| | - Mohammad Alhawarat
- Mother and Child Department, Ministry of Health, Prince Hamzah Street, Amman, Jordan
| | - Anais Valencia-Ruiz
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, Maryland 20817, United States of America; Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Oussama M'Hamdi
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, Maryland 20817, United States of America; Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Jennifer A Malia
- Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Zebiba Hassen
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, Maryland 20817, United States of America
| | - Mah'd M S Shafei
- Central Public Health Laboratory, Ministry of Health, King Hussein Street, Amman, Jordan
| | - Ala Y Alkhatib
- Voluntary Counselling and Testing Center, Ministry of Health, Ar Razi Street, Amman, Jordan
| | - Mahmoud Gazo
- Central Public Health Laboratory, Ministry of Health, King Hussein Street, Amman, Jordan
| | - Saied A Jaradat
- Princess Haya Biotechnology Center, Jordan University of Science and Technology, Ar-Ramtha street, P.O. Box 3030, Irbid, Jordan
| | - Yessenia Gomez
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Samantha McGeehon
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Melanie D McCauley
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Sarah C Moreland
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Janice M Darden
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Mihret Amare
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Trevor A Crowell
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, Maryland 20817, United States of America
| | - Sandhya Vasan
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, Maryland 20817, United States of America
| | - Nelson L Michael
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Julie A Ake
- United States Military HIV Research Program, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Paul T Scott
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Sheila A Peel
- Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America
| | - Shilpa Hakre
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, Maryland 20817, United States of America; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, Maryland 20910, United States of America.
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Koren MA, Lin L, Eckels KH, De La Barrera R, Dussupt V, Donofrio G, Sondergaard EL, Mills KT, Robb ML, Lee C, Adedeji O, Keiser PB, Curley JM, Copeland NK, Crowell TA, Hutter JN, Hamer MJ, Valencia-Ruiz A, Darden J, Peel S, Amare MF, Mebrahtu T, Costanzo M, Krebs SJ, Gromowski GD, Jarman RG, Thomas SJ, Michael NL, Modjarrad K. Safety and immunogenicity of a purified inactivated Zika virus vaccine candidate in adults primed with a Japanese encephalitis virus or yellow fever virus vaccine in the USA: a phase 1, randomised, double-blind, placebo-controlled clinical trial. Lancet Infect Dis 2023; 23:1175-1185. [PMID: 37390836 PMCID: PMC10877583 DOI: 10.1016/s1473-3099(23)00192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Zika virus infection is a threat to at-risk populations, causing major birth defects and serious neurological complications. Development of a safe and efficacious Zika virus vaccine is, therefore, a global health priority. Assessment of heterologous flavivirus vaccination is important given co-circulation of Japanese encephalitis virus and yellow fever virus with Zika virus. We investigated the effect of priming flavivirus naive participants with a licensed flavivirus vaccine on the safety and immunogenicity of a purified inactivated Zika vaccine (ZPIV). METHODS This phase 1, placebo-controlled, double-blind trial was done at the Walter Reed Army Institute of Research Clinical Trials Center in Silver Spring, MD, USA. Eligible participants were healthy adults aged 18-49 years, with no detectable evidence of previous flavivirus exposure (by infection or vaccination), as measured by a microneutralisation assay. Individuals with serological evidence of HIV, hepatitis B, or hepatitis C infection were excluded, as were pregnant or breastfeeding women. Participants were recruited sequentially into one of three groups (1:1:1) to receive no primer, two doses of intramuscular Japanese encephalitis virus vaccine (IXIARO), or a single dose of subcutaneous yellow fever virus vaccine (YF-VAX). Within each group, participants were randomly assigned (4:1) to receive intramuscular ZPIV or placebo. Priming vaccinations were given 72-96 days before ZPIV. ZPIV was administered either two or three times, at days 0, 28, and 196-234. The primary outcome was occurrence of solicited systemic and local adverse events along with serious adverse events and adverse events of special interest. These data were analysed in all participants receiving at least one dose of ZPIV or placebo. Secondary outcomes included measurement of neutralizing antibody responses following ZPIV vaccination in all volunteers with available post-vaccination data. This trial is registered at ClinicalTrials.gov, NCT02963909. FINDINGS Between Nov 7, 2016, and Oct 30, 2018, 134 participants were assessed for eligibility. 21 did not meet inclusion criteria, 29 met exclusion criteria, and ten declined to participate. 75 participants were recruited and randomly assigned. 35 (47%) of 75 participants were male and 40 (53%) were female. 25 (33%) of 75 participants identified as Black or African American and 42 (56%) identified as White. These proportions and other baseline characteristics were similar between groups. There were no statistically significant differences in age, gender, race, or BMI between those who did and did not opt into the third dose. All participants received the planned priming IXIARO and YF-VAX vaccinations, but one participant who received YF-VAX dropped out before receipt of the first dose of ZPIV. 50 participants received a third dose of ZPIV or placebo, including 14 flavivirus-naive people, 17 people primed with Japanese encephalitis virus vaccine, and 19 participants primed with yellow fever vaccine. Vaccinations were well tolerated across groups. Pain at the injection site was the only adverse event reported more frequently in participants who received ZPIV than in those who received placebo (39 [65%] of 60 participants, 95% CI 51·6-76·9 who received ZPIV vs three [21·4%] of 14 who received placebo; 4·7-50·8; p=0·006). No patients had an adverse event of special interest or serious adverse event related to study treatment. At day 57, the flavivirus-naive volunteers had an 88% (63·6-98·5, 15 of 17) seroconversion rate (neutralising antibody titre ≥1:10) and geometric mean neutralising antibody titre (GMT) against Zika virus of 100·8 (39·7-255·7). In the Japanese encephalitis vaccine-primed group, the day 57 seroconversion rate was 31·6% (95% CI 12·6-56·6, six of 19) and GMT was 11·8 (6·1-22·8). Participants primed with YF-VAX had a seroconversion rate of 25% (95% CI 8·7-49·1, five of 20) and GMT of 6·6 (5·2-8·4). Humoral immune responses rose substantially following a third dose of ZPIV, with seroconversion rates of 100% (69·2-100; ten of ten), 92·9% (66·1-99·8; 13 of 14), and 60% (32·2-83·7, nine of 15) and GMTs of 511·5 (177·6-1473·6), 174·2 (51·6-587·6), and 79 (19·0-326·8) in the flavivirus naive, Japanese encephalitis vaccine-primed, and yellow fever vaccine-primed groups, respectively. INTERPRETATION We found ZPIV to be well tolerated in flavivirus naive and primed adults but that immunogenicity varied significantly according to antecedent flavivirus vaccination status. Immune bias towards the flavivirus antigen of initial exposure and the timing of vaccination may have impacted responses. A third ZPIV dose overcame much, but not all, of the discrepancy in immunogenicity. The results of this phase 1 clinical trial have implications for further evaluation of ZPIV's immunisation schedule and use of concomitant vaccinations. FUNDING Department of Defense, Defense Health Agency; National Institute of Allergy and Infectious Diseases; and Division of Microbiology and Infectious Disease.
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Affiliation(s)
- Michael A Koren
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | - Leyi Lin
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kenneth H Eckels
- Pilot Bioproduction Facility, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rafael De La Barrera
- Pilot Bioproduction Facility, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Vincent Dussupt
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Gina Donofrio
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Erica L Sondergaard
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kristin T Mills
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Merlin L Robb
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Christine Lee
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | - Paul B Keiser
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Justin M Curley
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nathanial K Copeland
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Trevor A Crowell
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jack N Hutter
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Melinda J Hamer
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Anais Valencia-Ruiz
- Diagnostic Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Janice Darden
- Diagnostic Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Sheila Peel
- Diagnostic Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Mihret F Amare
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Tsedal Mebrahtu
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Margaret Costanzo
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Shelly J Krebs
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Gregory D Gromowski
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Stephen J Thomas
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nelson L Michael
- Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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