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Damhorst GL, McLendon K, Morales E, Solis ZM, Fitts E, Bowers HB, Sabino C, Sullivan J, Greenleaf M, Roback JD, Colasanti JA, Sheth AN, Titanji BK, Martin GS, Bassit L, Lam WA, Rao A. Performance of the Xpert™ Mpox PCR assay with oropharyngeal, anorectal, and cutaneous lesion swab specimens. J Clin Virol 2024; 171:105659. [PMID: 38430669 DOI: 10.1016/j.jcv.2024.105659] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
Anorectal and oropharyngeal exposures are implicated in sexual transmission of mpox, but authorized assays in the United States are only validated with cutaneous lesion swabs. Diagnostic assays for anorectal and oropharyngeal swabs are needed to address potential future outbreaks. The Cepheid Xpert® Mpox is the first point-of-care assay to receive FDA emergency use authorization in the United States and would be a valuable tool for evaluating these sample types. Our exploratory study demonstrates 100 % positive agreement with our in-house PCR assay for natural positive anorectal and oropharyngeal specimens and 92 % sensitivity with low-positive spiked specimens. The Xpert® assay detected viral DNA in specimens not detected by our reference PCR assay from four participants with mpox DNA at other sites, suggesting it may be more sensitive at low viral loads. In conclusion, the validation of the Xpert® for oropharyngeal and anorectal sample types can be rapidly achieved if clinical need returns and prospective samples become available.
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Affiliation(s)
- Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA; The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA; Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Kaleb McLendon
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Evelyn Morales
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Zianya M Solis
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Eric Fitts
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Heather B Bowers
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA; Department of Pediatrics, Emory University, Atlanta, GA, USA; Laboratory of Biochemical Pharmacology, Emory University, Atlanta, Georgia, USA
| | - Courtney Sabino
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA; Department of Pediatrics, Emory University, Atlanta, GA, USA; Laboratory of Biochemical Pharmacology, Emory University, Atlanta, Georgia, USA
| | - Julie Sullivan
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA
| | - Morgan Greenleaf
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA; Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA; Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA; Ponce de Leon Center, Grady Health System, Atlanta, Georgia, USA
| | - Greg S Martin
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA; Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Leda Bassit
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA; Department of Pediatrics, Emory University, Atlanta, GA, USA; Laboratory of Biochemical Pharmacology, Emory University, Atlanta, Georgia, USA
| | - Wilbur A Lam
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA; Department of Pediatrics, Emory University, Atlanta, GA, USA; Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Anuradha Rao
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, Georgia, USA; Department of Pediatrics, Emory University, Atlanta, GA, USA.
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2
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Aldred B, Scott JY, Aldredge A, Gromer DJ, Anderson AM, Cartwright EJ, Colasanti JA, Hall B, Jacob JT, Kalapila A, Kandiah S, Kelley CF, Lyles RH, Marconi VC, Nguyen ML, Rebolledo PA, Sheth AN, Szabo B, Titanji BK, Wiley Z, Workowski K, Cantos VD. Associations Between HIV and Severe Mpox in an Atlanta Cohort. J Infect Dis 2024; 229:S234-S242. [PMID: 38001044 DOI: 10.1093/infdis/jiad505] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/04/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In the Southeastern United States, the 2022 mpox outbreak disproportionately impacted people who are black and people with HIV (PWH). METHODS We analyzed a cohort of 395 individuals diagnosed with mpox across 3 health care systems in Atlanta, Georgia between 1 June 2022 and 7 October 2022. We present demographic and clinical characteristics and use multivariable logistic regression analyses to evaluate the association between HIV status and severe mpox (per the US Centers for Disease Control and Prevention definition) and, among PWH, the associations between CD4+ T-cell count and HIV load with severe mpox. RESULTS Of 395 people diagnosed with mpox, 384 (97.2%) were cisgender men, 335 (84.8%) identified as black, and 324 (82.0%) were PWH. Of 257 PWH with a known HIV load, 90 (35.0%) had > 200 copies/mL. Severe mpox occurred in 77 (19.5%) individuals and there was 1 (0.3%) death. Tecovirimat was prescribed to 112 (28.4%) people, including 56 (72.7%) people with severe mpox. In the multivariable analysis of the total population, PWH had 2.52 times higher odds of severe mpox (95% confidence interval [CI], 1.01-6.27) compared with people without HIV. In the multivariable analysis of PWH, individuals with HIV load > 200 copies/mL had 2.10 (95% CI, 1.00-4.39) times higher odds of severe mpox than PWH who were virologically suppressed. Lower CD4+ T-cell count showed a significant univariate association with severe mpox but was not found to be significantly associated with severe mpox in multivariable analysis. CONCLUSIONS PWH with nonsuppressed HIV loads had more mpox complications, hospitalizations, and protracted disease courses than people without HIV or PWH with suppressed viral loads. PWH with nonsuppressed HIV loads who are diagnosed with mpox warrant particularly aggressive monitoring and treatment.
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Affiliation(s)
- Bruce Aldred
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Jane Y Scott
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amalia Aldredge
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Daniel J Gromer
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
| | - Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Emily J Cartwright
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Betsy Hall
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Jesse T Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Aley Kalapila
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Sheetal Kandiah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Robert H Lyles
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
| | - Minh Ly Nguyen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Paulina A Rebolledo
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Brittany Szabo
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
| | - Zanthia Wiley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kimberly Workowski
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Valeria D Cantos
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- The Ponce Center, Grady Health System, Atlanta, Georgia, USA
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Damhorst GL, Fujita AW, Fitts E, Szabo B, Bowers HB, Sabino C, Ahmed A, Wang E, Piantadosi A, McLendon K, Sullivan J, Greenleaf M, McCaslin D, Palmore M, Anderson AM, Aldred B, Gunthel C, Martin GS, Colasanti JA, Lam WA, Bassit L, Rao A, Sheth AN, Titanji BK. Multisite Mpox Infection and Viral Dynamics Among Persons With HIV in Metro Atlanta. J Infect Dis 2024; 229:S213-S218. [PMID: 38019187 DOI: 10.1093/infdis/jiad530] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Abstract
The 2022 mpox outbreak primarily involved sexual transmission among men who have sex with men and disproportionately affected persons with human immunodeficiency virus (HIV). We examined viral dynamics and clinical features in a cohort evaluated for mpox infection at a comprehensive HIV clinic in Atlanta, Georgia. Viral DNA was found in 8 oropharyngeal and 5 anorectal specimens among 10 mpox cases confirmed by lesion swab polymerase chain reaction. Within-participant anatomic site of lowest cycle threshold (Ct) value varied, and lower Ct values were found in oropharyngeal and anorectal swabs when corresponding symptoms were present. This provides insight into mpox infection across multiple anatomic sites among people with HIV.
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Affiliation(s)
- Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
| | - A Wendy Fujita
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Eric Fitts
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pathology and Laboratory Medicine
| | - Brittany Szabo
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Heather B Bowers
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | - Courtney Sabino
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | | | - Ethan Wang
- Department of Pathology and Laboratory Medicine
| | - Anne Piantadosi
- Division of Infectious Diseases, Department of Medicine, Emory University
- Department of Pathology and Laboratory Medicine
| | | | - Julie Sullivan
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
| | - Morgan Greenleaf
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
| | | | - Melody Palmore
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Bruce Aldred
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Clifford Gunthel
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Greg S Martin
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Wilbur A Lam
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Leda Bassit
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | - Anuradha Rao
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Boghuma K Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
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4
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Aldred B, Lyles RH, Scott JY, Gromer DJ, Aldredge A, Workowski KA, Wiley Z, Titanji BK, Szabo B, Sheth AN, Rebolledo PA, Nguyen ML, Marconi VC, Kelley CF, Kandiah S, Kalapila A, Jacob JT, Hall B, Colasanti JA, Cartwright EJ, Cantos VD. Early Tecovirimat Treatment for Mpox Disease Among People With HIV. JAMA Intern Med 2024; 184:275-279. [PMID: 38190312 PMCID: PMC10912958 DOI: 10.1001/jamainternmed.2023.7696] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/09/2023] [Indexed: 01/10/2024]
Abstract
Importance Despite a lack of effectiveness data in humans, tecovirimat was widely prescribed to people with HIV (PWH) with mpox during the 2022 mpox epidemic, particularly PWH with low CD4+ T-cell counts or severe mpox clinical manifestations. Objective To evaluate if PWH with mpox who were treated with tecovirimat within 7 days of symptom onset were less likely to have mpox disease progression. Design, Setting, and Participants This cohort study included PWH diagnosed with mpox at 4 hospitals in Atlanta, Georgia, between June 1 and October 7, 2022. Patients were grouped according to whether they were treated with tecovirimat within 7 days of mpox symptom onset (early tecovirimat cohort) or they did not receive tecovirimat or received the drug 7 or more days after symptom onset (late or no tecovirimat cohort). Multivariable logistic regression models were used to identify factors associated with progression of mpox disease. The 2 cohorts were then matched 1:1 using propensity scores based on the identified factors, and mpox disease progression was compared. Exposures Treatment with tecovirimat within 7 days of mpox symptom onset. Main Outcome and Measures Progression of mpox disease, defined as the development of at least 1 severe mpox criterion established by the US Centers for Disease Control and Prevention, after symptom day 7. Results After propensity score matching, a total of 112 PWH were included in the analysis; 56 received tecovirimat within 7 days of mpox symptom onset (early tecovirimat group) and 56 were either treated later or did not receive tecovirimat (late or no tecovirimat group). In the early tecovirimat group, the median (IQR) age was 35 (30-42) years; 54 individuals (96.4%) were cisgender men, 46 (82.1%) were Black individuals, and 10 (17.9%) were individuals of other races (American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, or White) or unknown race. In the late or no tecovirimat group, the median (IQR) age was 36 (32-43) years; 54 (96.4%) were cisgender men, 49 (87.5%) were Black individuals, and 7 (12.5%) were individuals of other races or unknown race. Mpox disease progression occurred in 3 PWH (5.4%) in the early tecovirimat group and in 15 PWH (26.8%) in the late or no tecovirimat group (paired odds ratio, 13.00 [95% CI, 1.71-99.40]; P = .002). Conclusion and Relevance Results of this cohort study support starting tecovirimat in all PWH as soon as an mpox diagnosis is suspected. Additional research is warranted to confirm these findings.
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Affiliation(s)
- Bruce Aldred
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Robert H. Lyles
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jane Y. Scott
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel J. Gromer
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Amalia Aldredge
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Kimberly A. Workowski
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zanthia Wiley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Boghuma K. Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Brittany Szabo
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Anandi N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Paulina A. Rebolledo
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Minh Ly Nguyen
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Vincent C. Marconi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Colleen F. Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Sheetal Kandiah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Aley Kalapila
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Jesse T. Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Betsy Hall
- The Ponce Center, Grady Health System, Atlanta, Georgia
| | - Jonathan A. Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily J. Cartwright
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Valeria D. Cantos
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- The Ponce Center, Grady Health System, Atlanta, Georgia
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Titanji BK, Sereti I, Singer BD. Culturing the Future of Medicine: The Imperative of Strengthening the ID Physician-Scientist Pipeline. J Infect Dis 2024:jiae074. [PMID: 38365222 DOI: 10.1093/infdis/jiae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 02/18/2024] Open
Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Benjamin D Singer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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6
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Tegomoh B, Titanji BK. Close the gender gap in Africa's HIV epidemic. Nat Microbiol 2024; 9:8-10. [PMID: 38082148 DOI: 10.1038/s41564-023-01535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Affiliation(s)
- Bryan Tegomoh
- University of California, Berkeley School of Public Health, Berkeley, CA, USA
| | - Boghuma K Titanji
- Division of Infectious Disease, Emory University School of Medicine, Atlanta, GA, USA.
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Zucker J, Hazra A, Titanji BK. Mpox and HIV-Collision of Two Diseases. Curr HIV/AIDS Rep 2023; 20:440-450. [PMID: 37994953 DOI: 10.1007/s11904-023-00682-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE OF REVIEW The global outbreak of mpox has brought renewed attention to a previously neglected disease which is particularly severe in people with underlying untreated HIV co-infection. For this population, the disease is progressive, severe, and often lethal. In this review, we examine the pathogenesis of mpox disease and its collision with co-existent HIV infection and discuss key considerations for management as well as emerging clinical dilemmas and areas for future research. RECENT FINDINGS Co-existent untreated HIV infection characterized by severe immunocompromise potentiates the nefarious effects of monkeypox virus infection leading to severe manifestations of mpox. Treating mpox in the context of HIV requires mpox-directed therapies, supportive care, and HIV-specific treatment to restore immune function. Preventative measures for PWH are like those in healthy individuals, but the effectiveness and durability of protection conferred by existing vaccines in PWH remain to be fully characterized. Mpox is an important opportunistic infection in PWH. Clinicians should be aware of the unique features of the disease in this population and approaches to care and management of mpox in PWH.
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Affiliation(s)
- Jason Zucker
- Department of Infectious Diseases, Columbia University, New York, NY, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Health Sciences Research Building I, Emory University School of Medicine, 1760 Haygood Drive NE, W300, Rm 327, Atlanta, GA, USA.
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Titanji BK, Eick-Cost A, Partan ES, Epstein L, Wells N, Stahlman SL, Devineni P, Munyoki B, Pyarajan S, Balajee A, Smith J, Woods CW, Holodniy M, Davey VJ, Bonomo RA, Young-Xu Y, Marconi VC. Effectiveness of Smallpox Vaccination to Prevent Mpox in Military Personnel. N Engl J Med 2023; 389:1147-1148. [PMID: 37733313 PMCID: PMC10559046 DOI: 10.1056/nejmc2300805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Abirami Balajee
- White River Junction Veterans Affairs Medical Center, White River Junction, VT
| | - Jeremy Smith
- White River Junction Veterans Affairs Medical Center, White River Junction, VT
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9
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Titanji BK, Mekone I, Scales D, Ndoula ST, Seungue J, Gorman S. Pre-emptively tackling vaccine misinformation for a successful large-scale roll-out of malaria vaccines in Africa. Lancet Infect Dis 2023; 23:997-999. [PMID: 37506727 DOI: 10.1016/s1473-3099(23)00453-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, 30322 GA, USA; Médecins du Cameroon (MEDCAMER), Yaoundé, Cameroon; CRITICA, Bronx, NY, USA.
| | - Isabelle Mekone
- Department of Pediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - David Scales
- Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA; CRITICA, Bronx, NY, USA
| | - Shalom Tchokfe Ndoula
- Expanded Program on Immunization, Ministry of Public Health Cameroon, Yaoundé, Cameroon
| | - Judith Seungue
- Expanded Program on Immunization, Ministry of Public Health Cameroon, Yaoundé, Cameroon
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Titanji BK, Boulware DR, Bender Ignacio RA. Strategies for Expediting Clinical Trials in the Next Public Health Emergency. JAMA Health Forum 2023; 4:e233191. [PMID: 37773506 DOI: 10.1001/jamahealthforum.2023.3191] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
This Viewpoint highlights areas for improving implementation of future epidemic clinical trials, focusing on research among nonhospitalized persons.
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Affiliation(s)
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis
| | - Rachel A Bender Ignacio
- Division of Allergy and Infectious Diseases, University of Washington, Seattle
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington
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11
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Mfuh KO, Abanda NN, Titanji BK. Strengthening diagnostic capacity in Africa as a key pillar of public health and pandemic preparedness. PLOS Glob Public Health 2023; 3:e0001998. [PMID: 37310963 DOI: 10.1371/journal.pgph.0001998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Kenji O Mfuh
- Department of Anatomic Pathology and Clinical Laboratories, Stanford Medicine, Palo Alto, California, United States of America
| | - Ngu Njei Abanda
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
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12
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Titanji BK, Pai M. Leveraging the positives from the pandemic to strengthen infectious disease care in low-income and middle-income countries. Lancet Infect Dis 2023:S1473-3099(23)00354-7. [PMID: 37290475 PMCID: PMC10241487 DOI: 10.1016/s1473-3099(23)00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Disease, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Madhukar Pai
- School of Population and Global Health, McGill University, Montreal, QC H3A 1G1, Canada; Manipal McGill Program in Infectious Diseases, Manipal Center for Infectious Diseases, Manipal Academy of Higher Education, Manipal, India.
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13
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Titanji BK. ARTful ageing: epigenetic rejuvenation in people with HIV. Lancet Healthy Longev 2023; 4:e181-e182. [PMID: 37148888 DOI: 10.1016/s2666-7568(23)00059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 05/08/2023] Open
Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA.
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14
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Wilber E, Rebolledo PA, Kasinathan V, Merritt S, Titanji BK, Aldred B, Kandiah S, Ray SM, Sheth AN, Colasanti JA, Wang YF. Utility of a Viral Vesicular Panel Multiplex PCR Assay for the Diagnosis of Monkeypox, Herpes Simplex, and Varicella Zoster Viruses. Open Forum Infect Dis 2023; 10:ofad140. [PMID: 37008566 PMCID: PMC10051014 DOI: 10.1093/ofid/ofad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Abstract
Mpox represents a diagnostic challenge due to varied clinical presentations and multiple mimics. A commercially available multiplex PCR panel accurately detects mpox virus as well as common mimics (HSV, VZV) in clinical specimens and could be used in routine clinical, surveillance, and outbreak settings.
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Affiliation(s)
- Eli Wilber
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
| | - Paulina A Rebolledo
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
- Grady Healthcare System , Atlanta, Georgia , USA
| | - Vyjayanti Kasinathan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | | | - Boghuma K Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
| | - Bruce Aldred
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
| | - Sheetal Kandiah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
| | - Susan M Ray
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
- Grady Healthcare System , Atlanta, Georgia , USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
- Grady Healthcare System , Atlanta, Georgia , USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
- Grady Healthcare System , Atlanta, Georgia , USA
| | - Yun F Wang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
- Grady Memorial Hospital, Clinical Laboratory , Atlanta, GA , USA
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15
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Shelly CE, Logan C, Skorochod B, Wiyeh A, Ndwandwe D, Choko A, Valea I, Titanji BK. Creating a best practice template for participant communication plans in global health clinical studies. Trials 2023; 24:158. [PMID: 36864516 PMCID: PMC9983505 DOI: 10.1186/s13063-023-07185-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/18/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Clinical trial participants have a right to be informed throughout the entire process of human subject research. As part of this pillar of research ethics, participants and other stakeholders should be made aware of research findings after a trial has been completed. Though participants have both a right, and a desire to be informed of research outcomes, studies show that they rarely receive communication about study findings. Our aim was (1) to understand what, if any, role communication plans play in current global health clinical research protocols and (2) to use our findings to develop a communication plan template tailored to clinical research carried out in low-and-middle-income countries (LMIC) while minimizing colonial assumptions. While the template was drafted in the LMIC context, the principles are universally applicable and should be considered best practices for all global health clinical trials. METHODS We carried out a mixed-method study over a period of 6 months to understand the role of communication with study participants and other stakeholders in clinical trials. The semiquantitative analysis included mining publicly available clinical trial protocols for communication-related language. Qualitative interviews (n = 7) were used to gather knowledge and insight from clinical trial experts to inform the development of a communication plan template. RESULTS None of the 48 mined clinical trial protocols included a communication plan. Of the 48, 21% (n = 21) protocols included communication-related language, and 10% (n = 5) described plans to share trial results with participants. CONCLUSION The use of communication plans in global health clinical trials is lacking. To our knowledge, this is the first in-depth analysis of communication plans in clinical trials to date. We recommend that researchers utilize the developed communication plan template throughout the entire research process to ensure a human-centered approach to participant communication. This communication plan should apply to all phases of a research trial, with a particular emphasis on plans to share results in an accessible and engaging manner once the trial has been completed.
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Affiliation(s)
| | - Caroline Logan
- CollaborateUp Inc, 208 Noland Street, Falls Church, VA, USA
| | - Beth Skorochod
- CollaborateUp Inc, 208 Noland Street, Falls Church, VA, USA
| | - Alison Wiyeh
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Francie Van Zilj Drive, Parow Valley, Cape Town, South Africa
| | - Augustine Choko
- The Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Innocent Valea
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital College of Medicine, Blantyre 3, Malawi, C, P.O. Box 30096, Chichiri, South Africa
| | - Boghuma K Titanji
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA, USA
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16
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Titanji BK, Marconi VC. Vaxxing to elimination: smallpox vaccines as tools to fight mpox. J Clin Invest 2023; 133:167632. [PMID: 36647829 PMCID: PMC9843044 DOI: 10.1172/jci167632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Boghuma K. Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Vincent C. Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.,Department of Global Health, Emory University, Atlanta, Georgia, USA.,Emory University Vaccine Center, Atlanta, Georgia, USA
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Abstract
Monkeypox is a zoonotic illness caused by the monkeypox virus, an Orthopoxvirus in the same genus as the variola, vaccinia, and cowpox viruses. Since the detection of the first human case in the Democratic Republic of the Congo in 1970, the disease has caused sporadic infections and outbreaks, mainly restricted to some countries in west and central Africa. In July, 2022, WHO declared monkeypox a Public Health Emergency of International Concern, on account of the unprecedented global spread of the disease outside previously endemic countries in Africa and the need for global solidarity to address this previously neglected disease. The 2022 outbreak has been primarily associated with close intimate contact (including sexual activity) and most cases have been diagnosed among men who have sex with men, who often present with novel epidemiological and clinical characteristics. In the 2022 outbreak, the incubation period ranges from 7 days to 10 days and most patients present with a systemic illness that includes fever and myalgia and a characteristic rash, with papules that evolve to vesicles, pustules, and crusts in the genital, anal, or oral regions and often involve the mucosa. Complications that require medical treatment (eg, antiviral therapy, antibacterials, and pain control) occur in up to 40% of patients and include rectal pain, odynophagia, penile oedema, and skin and anorectal abscesses. Most patients have a self-limited illness; between 1% and 13% require hospital admission (for treatment or isolation), and the case-fatality rate is less than 0·1%. A diagnosis can be made through the presence of Orthopoxvirus DNA in PCRs from lesion swabs or body fluids. Patients with severe manifestations and people at risk of severe disease (eg, immunosuppressed people) could benefit from antiviral treatment (eg, tecovirimat). The current strategy for post-exposure prophylaxis or pre-exposure prophylaxis for people at high risk is vaccination with the non-replicating modified vaccinia Ankara. Antiviral treatment and vaccines are not yet available in endemic countries in Africa.
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Affiliation(s)
- Oriol Mitjà
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections section, Hospital Universitari Germans Trías i Pujol, Badalona, Spain; Fight Infectious Diseases Foundation, Badalona, Spain; School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
| | - Dimie Ogoina
- Department of Internal Medicine, Infectious Diseases Unit, Niger Delta University and Niger Delta University Teaching Hospital, Bayelsa, Nigeria
| | - Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Medecins du Cameroun (Medcamer), Yaoundé, Cameroon
| | | | - Jean-Jacques Muyembe
- Institut National de Recherche Biomedicale, Kinshasa, Democratic Republic of the Congo
| | - Michael Marks
- London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK; Division of Infection and Immunology, University College London, London, UK
| | - Chloe M Orkin
- Centre for Immunobiology, Blizard Institute, Queen Mary University, London, UK
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18
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Titanji BK. The Last Mile Problem - COVID-19 Vaccine Coverage Among the Most Socially Vulnerable. Clin Infect Dis 2023; 76:1626-1627. [PMID: 36611245 DOI: 10.1093/cid/ciad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Affiliation(s)
- Boghuma K Titanji
- Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA.,Emory Center for AIDS research, Atlanta Georgia
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19
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Henao-Martínez AF, Orkin CM, Titanji BK, Rodriguez-Morales AJ, Salinas JL, Franco-Paredes C, Tuells J, Chastain DB. Hospitalization risk among patients with Mpox infection-a propensity score matched analysis. Ther Adv Infect Dis 2023; 10:20499361231196683. [PMID: 37663111 PMCID: PMC10469242 DOI: 10.1177/20499361231196683] [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: 06/01/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background Monkeypox (Mpox) is a reemerging, neglected viral disease. By May 2023, worldwide Mpox cases surpassed 87,000. Predictive factors for hospitalization with Mpox are lacking. Objective We aim to compare clinical characteristics and outcomes in hospitalized and nonhospitalized patients with Mpox infection. Design A multicenter retrospective case-control cohort of patients with Mpox infection. Methods We performed a propensity score match analysis from a global health network (TrinetX). We compare clinical characteristics and outcomes between hospitalized and nonhospitalized patients with Mpox. Results Of 1477 patients, 6% were hospitalized, 52% required an ED visit, and 29% received treatment at urgent care. After propensity score matching, 80 patients remained in each group. Hospitalizations were more common among Black persons (51% versus 33%, p = 0.01), people with HIV (50% versus 20%, p < 0.0001), and those with proctitis (44% versus 12.5%, p < 0.001). Conclusion Independent predictive factors of hospitalization in our cohort for Mpox included people who are Black with a diagnosis of HIV, severe proctitis, pain requiring opioids, and elevated lactate dehydrogenase. Greater recognition of factors associated with increased risk of Mpox severity and hospitalization is paramount.
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Affiliation(s)
- Andrés F. Henao-Martínez
- University of Colorado Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO 80045, USA
| | - Chloe M. Orkin
- SHARE Collaborative, Queen Mary University of London, London, UK
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Boghuma K. Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Alfonso J. Rodriguez-Morales
- Master of Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Jorge L. Salinas
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Carlos Franco-Paredes
- Hospital Infantil de México, Ciudad de México, Mexico
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Panamá City, Panama
| | - Jose Tuells
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, Universidad de Alicante, Alicante, Spain
| | - Daniel B. Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
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20
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Thornhill JP, Palich R, Ghosn J, Walmsley S, Moschese D, Cortes CP, Galliez RM, Garlin AB, Nozza S, Mitja O, Radix AE, Blanco JL, Crabtree-Ramirez B, Thompson M, Wiese L, Schulbin H, Levcovich A, Falcone M, Lucchini A, Sendagorta E, Treutiger CJ, Byrne R, Coyne K, Meyerowitz EA, Grahn AM, Hansen ABE, Pourcher V, DellaPiazza M, Lee R, Stoeckle M, Hazra A, Apea V, Rubenstein E, Jones J, Wilkin A, Ganesan A, Henao-Martínez AF, Chow EJ, Titanji BK, Zucker JE, Ogoina D, Orkin CM. Human monkeypox virus infection in women and non-binary individuals during the 2022 outbreaks: a global case series. Lancet 2022; 400:1953-1965. [PMID: 36403584 PMCID: PMC9671743 DOI: 10.1016/s0140-6736(22)02187-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Between May and November, 2022, global outbreaks of human monkeypox virus infection have been reported in more than 78 000 people worldwide, predominantly in men who have sex with men. We describe the epidemiological and clinical characteristics of monkeypox virus infection in cisgender (cis) and transgender (trans) women and non-binary individuals assigned female sex at birth to improve identification and understanding of risk factors. METHODS International collaborators in geographical locations with high numbers of diagnoses of monkeypox virus infection were approached and invited to contribute data on women and non-binary individuals with confirmed monkeypox virus infection. Contributing centres completed deidentified structured case-report spreadsheets, adapted and developed by participating clinicians, to include variables of interest relevant to women and non-binary individuals assigned female at birth. We describe the epidemiology and clinical course observed in the reported infections. FINDINGS Collaborators reported data for a total of 136 individuals with monkeypox virus infection who presented between May 11 and Oct 4, 2022, across 15 countries. Overall median age was 34 years (IQR 28-40; range 19-84). The cohort comprised 62 trans women, 69 cis women, and five non-binary individuals (who were, because of small numbers, grouped with cis women to form a category of people assigned female at birth for the purpose of comparison). 121 (89%) of 136 individuals reported sex with men. 37 (27%) of all individuals were living with HIV, with a higher proportion among trans women (31 [50%] of 62) than among cis women and non-binary individuals (six [8%] of 74). Sexual transmission was suspected in 55 (89%) trans women (with the remainder having an unknown route of transmission) and 45 (61%) cis women and non-binary individuals; non-sexual routes of transmission (including household and occupational exposures) were reported only in cis women and non-binary individuals. 25 (34%) of 74 cis women and non-binary individuals submitted to the case series were initially misdiagnosed. Overall, among individuals with available data, rash was described in 124 (93%) of 134 individuals and described as anogenital in 95 (74%) of 129 and as vesiculopustular in 105 (87%) of 121. Median number of lesions was ten (IQR 5-24; range 1-200). Mucosal lesions involving the vagina, anus, or oropharynx or eye occurred in 65 (55%) of 119 individuals with available data. Vaginal and anal sex were associated with lesions at those sites. Monkeypox virus DNA was detected by PCR from vaginal swab samples in all 14 samples tested. 17 (13%) individuals were hospitalised, predominantly for bacterial superinfection of lesions and pain management. 33 (24%) individuals were treated with tecovirimat and six (4%) received post-exposure vaccinations. No deaths were reported. INTERPRETATION The clinical features of monkeypox in women and non-binary individuals were similar to those described in men, including the presence of anal and genital lesions with prominent mucosal involvement. Anatomically, anogenital lesions were reflective of sexual practices: vulvovaginal lesions predominated in cis women and non-binary individuals and anorectal features predominated in trans women. The prevalence of HIV co-infection in the cohort was high. FUNDING None.
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Affiliation(s)
- John P Thornhill
- Department of Infection and Immunity, Blizard Institute and SHARE Collaborative, Queen Mary University of London, Barts Health NHS Trust, London, UK
| | - Romain Palich
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre Louis Epidemiology and Public Health Institute, Sorbonne University, INSERM 1136, Paris, France
| | - Jade Ghosn
- Department of Infectious Diseases, Bichât University Hospital, Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, INSERM U1137, IAME, Paris, France
| | - Sharon Walmsley
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Davide Moschese
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Rafael Mello Galliez
- Núcleo de Enfrentamento e Estudos de Doenças Infecciosas Emergentes e Reemergentes, Departamento de Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Amy B Garlin
- Disease Prevention and Control Branch, Population Health Division, San Francisco Department of Public Health, San Francisco, CA, USA; Division of Infectious Diseases and Vaccinology, Berkeley School of Public Health, University of California, San Francisco, CA, USA
| | - Silvia Nozza
- Department of Infectious and Tropical Diseases, IRCCS-Ospedale San Raffaele, Milan, Italy
| | - Oriol Mitja
- Skin Neglected Tropical Diseases and Sexually Transmitted Infections Section, Fight Infectious Diseases Foundation, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Asa E Radix
- Department of Medicine, Callen-Lorde Community Health Center, NYU Grossman School of Medicine, New York, NY, USA
| | - Jose Luis Blanco
- Servicio de Enfermedades Infecciosas, Hospital Clinic de Barcelona, Universidad de Barcelona, Instituto para la Investigación Médica August Pi I Suñe, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Brenda Crabtree-Ramirez
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | | | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Marco Falcone
- Infectious Diseases Unit, Cisanello University Hospital, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Anna Lucchini
- Sexual Health Clinic, National Health Service, Torino, Italy
| | - Elena Sendagorta
- Servicio de Dermatología, Hospital Universitario La Paz, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Carl-Johan Treutiger
- Department of Infectious Diseases/Venhälsan, South General Hospital, Stockholm, Sweden
| | - Ruth Byrne
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | - Anna M Grahn
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ann-Brit Eg Hansen
- Department of Infectious Diseases, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Valerie Pourcher
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre Louis Epidemiology and Public Health Institute, Sorbonne University, INSERM 1136, Paris, France
| | - Michelle DellaPiazza
- Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Rachel Lee
- George Washington University Hospital, Washington, DC, USA
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Vanessa Apea
- Department of Global Health, Wolfson Institute and SHARE Collaborative, Queen Mary University of London, Barts Health NHS Trust, London, UK
| | - Emma Rubenstein
- Department of Infectious Diseases, Saint-Louis and Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Joyce Jones
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aimee Wilkin
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, The Henry M Jackson Foundation for the Advancement of Military Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Eric J Chow
- Public Health-Seattle & King County, Seattle, WA, USA; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Boghuma K Titanji
- Department of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason E Zucker
- Columbia University Irving Medical Center, New York, NY, USA
| | - Dimie Ogoina
- Infectious Diseases Unit, Department of Internal Medicine, Niger Delta University, Amassoma, Niger; Niger Delta University Teaching Hospital, Okolobir, Bayelsa, Nigeria
| | - Chloe M Orkin
- Department of Infection and Immunity, Blizard Institute and SHARE Collaborative, Queen Mary University of London, Barts Health NHS Trust, London, UK.
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21
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Titanji BK, Lee M, Wang Z, Chen J, Hui Q, Lo Re III V, So-Armah K, Justice AC, Xu K, Freiberg M, Gwinn M, Marconi VC, Sun YV. Epigenome-wide association study of biomarkers of liver function identifies albumin-associated DNA methylation sites among male veterans with HIV. Front Genet 2022; 13:1020871. [PMID: 36303554 PMCID: PMC9592923 DOI: 10.3389/fgene.2022.1020871] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Liver disease (LD) is an important cause of morbidity and mortality for people with HIV (PWH). The molecular factors linked with LD in PWH are varied and incompletely characterized. We performed an epigenome-wide association study (EWAS) to identify associations between DNA methylation (DNAm) and biomarkers of liver function-aspartate transaminase, alanine transaminase, albumin, total bilirubin, platelet count, FIB-4 score, and APRI score-in male United States veterans with HIV. Methods: Blood samples and clinical data were obtained from 960 HIV-infected male PWH from the Veterans Aging Cohort Study. DNAm was assessed using the Illumina 450K or the EPIC 850K array in two mutually exclusive subsets. We performed a meta-analysis for each DNAm site measured by either platform. We also examined the associations between four measures of DNAm age acceleration (AA) and liver biomarkers. Results: Nine DNAm sites were positively associated with serum albumin in the meta-analysis of the EPIC and 450K EWAS after correcting for multiple testing. Four DNAm sites (cg16936953, cg18942579, cg01409343, and cg12054453), annotated within the TMEM49 and four of the remaining five sites (cg18181703, cg03546163, cg20995564, and cg23966214) annotated to SOCS3, FKBP5, ZEB2, and SAMD14 genes, respectively. The DNAm site, cg12992827, was not annotated to any known coding sequence. No significant associations were detected for the other six liver biomarkers. Higher PhenoAA was significantly associated with lower level of serum albumin (β = -0.007, p-value = 8.6 × 10-4, CI: -0.011116, -0.002884). Conclusion: We identified epigenetic associations of both individual DNAm sites and DNAm AA with liver function through serum albumin in men with HIV. Further replication analyses in independent cohorts are warranted to confirm the epigenetic mechanisms underlying liver function and LD in PWH.
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Affiliation(s)
- Boghuma K. Titanji
- Division of Infectious Disease, Emory School of Medicine, Atlanta, GA, United States
| | - Mitch Lee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Zeyuan Wang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Junyu Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Qin Hui
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Vincent Lo Re III
- Division of Infectious Diseases Department of Medicine and Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, United States
| | - Kaku So-Armah
- Boston University Medical School, Boston, MA, United States
| | - Amy C. Justice
- Connecticut Veteran Health System, West Haven, CT, United States,Yale University School of Medicine, New Haven, CT, United States
| | - Ke Xu
- Connecticut Veteran Health System, West Haven, CT, United States,Yale University School of Medicine, New Haven, CT, United States
| | - Matthew Freiberg
- Cardiovascular Medicine Division and Tennessee Valley Healthcare System, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Marta Gwinn
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Vincent C. Marconi
- Division of Infectious Disease, Emory School of Medicine, Atlanta, GA, United States,Atlanta Veterans Affairs Health Care System, Decatur, GA, United States,Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, United States,Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, United States
| | - Yan V. Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States,Atlanta Veterans Affairs Health Care System, Decatur, GA, United States,*Correspondence: Yan V. Sun,
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22
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Titanji BK, Wang Z, Chen J, Hui Q, So-Armah K, Freiberg M, Justice AC, Ke X, Marconi VC, Sun YV. Soluble CD14-associated DNA methylation sites predict mortality among men with HIV infection. AIDS 2022; 36:1563-1571. [PMID: 35979830 PMCID: PMC9394925 DOI: 10.1097/qad.0000000000003279] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Elevated plasma levels of sCD14 predict all-cause mortality in people with HIV (PWH). Epigenetic regulation plays a key role in infection and inflammation. To reveal the epigenetic relationships between sCD14, immune function and disease progression among PWH, we conducted an epigenome-wide association study (EWAS) of sCD14 and investigated the relationship with mortality. DESIGN AND METHODS DNA methylation (DNAm) levels of peripheral blood samples from PWH in the Veterans Aging Cohort Study (VACS) were measured using the Illumina Infinium Methylation 450K (n = 549) and EPIC (850K) BeadChip (n = 526). Adjusted for covariates and multiple testing, we conducted an epigenome-wide discovery, replication, and meta-analysis to identify significant associations with sCD14. We then examined and replicated the relationship between the principal epigenetic sites and survival using Cox regression models. FINDINGS We identified 118 DNAm sites significantly associated with sCD14 in the meta-analysis of 1075 PWH. The principal associated DNAm sites mapped to genes (e.g. STAT1, PARP9, IFITM1, MX1, and IFIT1) related to inflammation and antiviral response. Adjusting for multiple testing, 10 of 118 sCD14-associated DNAm sites significantly predicted survival time conditional on sCD14 levels. CONCLUSION The identification of DNAm sites independently predicting survival may improve our understanding of prognosis and potential therapeutic targets among PWH.
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Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine
| | - Zeyuan Wang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Junyu Chen
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Qin Hui
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Matthew Freiberg
- Cardiovascular Medicine Division and Tennessee Valley Healthcare System, Vanderbilt University Medical Center, Nashville, TN
| | - Amy C Justice
- Yale University School of Medicine, New Haven
- Connecticut Veteran Health System, West Haven, CT
| | - Xu Ke
- Yale University School of Medicine, New Haven
- Connecticut Veteran Health System, West Haven, CT
| | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of Medicine
- Atlanta Veterans Affairs Healthcare System, Decatur
- Hubert Department of Global Health, Rollins School of Public Health
- Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Atlanta Veterans Affairs Healthcare System, Decatur
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23
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Wilber E, Piantadosi A, Babiker A, McLendon K, O’Sick W, Fitts E, Webster AS, Verkerke H, Kim JS, Phadke VK, Rouphael N, Titanji BK, Blake WT, Howard-Anderson J, Roback JD, Lam WA, Damhorst GL. Nucleocapsid antigenemia in patients receiving anti-CD20 therapy with protracted COVID-19. Open Forum Infect Dis 2022; 9:ofac419. [PMID: 36043176 PMCID: PMC9416058 DOI: 10.1093/ofid/ofac419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Immunocompromised patients with prolonged coronavirus disease 2019 symptoms present diagnostic and therapeutic challenges. We measured viral nucleocapsid antigenemia in 3 patients treated with anti-CD20 immunotherapy who acquired severe acute respiratory syndrome coronavirus 2 infection and experienced protracted symptoms. Our results support nucleocapsid antigenemia as a marker of persistent infection and therapeutic response.
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Affiliation(s)
- Eli Wilber
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Anne Piantadosi
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Ahmed Babiker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Kaleb McLendon
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - William O’Sick
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Eric Fitts
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Andrew S Webster
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Hans Verkerke
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School , Boston, MA , USA
| | - James S Kim
- Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Varun K Phadke
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Nadine Rouphael
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - William T Blake
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Jessica Howard-Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Wilbur A Lam
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine , Atlanta, GA , USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies , Atlanta, GA , USA
- Aflac Cancer & Blood Disorders Center at Children's Healthcare of Atlanta , Atlanta, GA , USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology , Atlanta, GA , USA
| | - Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies , Atlanta, GA , USA
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24
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Mehta P, Titanji BK. Baricitinib in COVID-19: a coming-of-age from artificial intelligence to reducing mortality. Lancet 2022; 400:338-339. [PMID: 35908561 PMCID: PMC9333997 DOI: 10.1016/s0140-6736(22)01295-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Puja Mehta
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, London, UK; Department of Rheumatology, University College London Hospital NHS Trust, London, UK
| | - Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA.
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25
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Titanji BK. Neglecting emerging diseases - monkeypox is the latest price of a costly default. Med 2022; 3:433-434. [PMID: 35809556 PMCID: PMC9185854 DOI: 10.1016/j.medj.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Boghuma K Titanji
- Department of Infectious Diseases, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA.
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26
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Affiliation(s)
- Aula Abbara
- Manson Unit, Médecins Sans Frontières UK, London EC4A 1AB, UK; Department of Infection, Imperial College London, London, UK.
| | - Bhargavi Rao
- Manson Unit, Médecins Sans Frontières UK, London EC4A 1AB, UK; Department of Global Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Boghuma K Titanji
- Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Yap Boum
- Epicentre, Médecins Sans Frontières, Yaoundé, Cameroon; Public Health Emergency Operation Centre, Ministry of Public Health, Yaoundé, Cameroon
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; National Institute for Health and Care Research Biomedical Research Centre, University College London, London, UK
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27
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28
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Titanji BK, Abdul-Mutakabbir JC, Christophers B, Flores L, Marcelin JR, Swartz TH. Social Media: Flattening Hierarchies for Women and Black, Indigenous, People Of Color (BIPOC) to Enter the Room Where It Happens. Clin Infect Dis 2022; 74:S222-S228. [PMID: 35568478 PMCID: PMC9107375 DOI: 10.1093/cid/ciac047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Social media platforms are widely used to connect people across multiple settings, including country of origin, profession, race/ethnicity, sexual orientation, gender identity, seniority, and training. Groups that have been marginalized or historically excluded from decision-making encounters may lack formal mentors/sponsors because of a lack of representation of women and Black, Indigenous, People Of Color (BIPOC) in senior leadership positions. This can serve as a barrier to professional advancement at all stages of career development. Identifying and connecting with these potential mentors/sponsors outside of one's institutional space can be challenging. For this reason, leveraging social media to develop these professional relationships through flattened hierarchies can allow for professional networking beyond traditional mechanisms. Here we aim to describe how individuals can connect through social media to advance their careers and scientific and clinical expertise, advocate for communities, and provide high-quality communication to the public.
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Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jacinda C Abdul-Mutakabbir
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA.,Department of Basic Science, Loma Linda School of Medicine, Loma Linda, California, USA
| | - Briana Christophers
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York, USA
| | - Laura Flores
- University of Nebraska Medical Center, College of Allied Health Professions, Omaha, Nebraska, USA
| | - Jasmine R Marcelin
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USAand
| | - Talia H Swartz
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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29
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Cawcutt KA, Marcelin JR, Cortés-Penfield N, Cutrell JB, Dong SW, Mahoney MV, McCarty TP, Mediwala Hornback K, Titanji BK, Woc-Colburn LE, Schwartz IS. #SoMe the Money! Value, Strategy, and Implementation of Social Media Engagement for Infectious Diseases Trainees, Clinicians, and Divisions. Clin Infect Dis 2022; 74:S229-S236. [PMID: 35568477 DOI: 10.1093/cid/ciac063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/09/2021] [Indexed: 12/22/2022] Open
Abstract
Social media platforms have revolutionized how we consume information, along with how to effectively present communication, education, and advocacy efforts. There is profound value in leveraging social media within these aspects for the field of infectious diseases, for divisions and individual clinicians. Herein, we provide the rationale to incorporate social media as a key competency for infectious diseases training and specific guidance on aspects of education and strategic development of new accounts critical for success.
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Affiliation(s)
- Kelly A Cawcutt
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jasmine R Marcelin
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Nicolás Cortés-Penfield
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - James B Cutrell
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sara W Dong
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Monica V Mahoney
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Todd P McCarty
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Krutika Mediwala Hornback
- Department of Pharmacy Practice, Medical University of South Carolina (MUSC) Health, Charleston, South Carolina, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USAand
| | - Laila E Woc-Colburn
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USAand
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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30
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Schwartz IS, McCarty T, Woc-Colburn LE, Titanji BK, Cutrell JB, Cortes-Penfield NW. Educational Impact of #IDJClub, a Twitter-Based Infectious Diseases Journal Club. Clin Infect Dis 2022; 74:S244-S250. [PMID: 35568479 PMCID: PMC9383960 DOI: 10.1093/cid/ciac108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Journal clubs have been an enduring mainstay of medical education, and hosting these on social media platforms can expand accessibility and engagement. We describe the creation and impact of #IDJClub, an infectious diseases (ID) Twitter journal club. METHODS We launched #IDJClub in October 2019. Using the account @IDJClub, an ID physician leads a 1-hour open-access Twitter discussion of a recent publication. All participants use the hashtag #IDJClub. Sessions started monthly, but increased due to demand during the coronavirus disease 2019 (COVID-19) pandemic. We used Symplur 's Healthcare Hashtag project to track engagement of #IDJClub per 60-minute discussion plus the following 30 minutes to capture ongoing conversations. We also conducted an online anonymous survey using Likert scales and open-ended questions to assess educational impact. RESULTS In its first 20 months, 31 journal clubs were held, with medians of 42 (interquartile range [IQR], 28.5-60) participants and 312 (IQR, 205-427.5) tweets per session. 134 participants completed the survey, of whom 39% were ID physicians, 19% pharmacists, 13% ID fellows, and 10% medical residents. Most agreed or strongly agreed that #IDJClub provided clinically useful knowledge (95%), increased personal confidence in independent literature appraisal (72%), and was more educational than traditional journal clubs (72%). The format addressed several barriers to traditional journal club participation such as lack of access, subject experts, and time. CONCLUSIONS #IDJClub is an effective virtual journal club, providing an engaging, open-access tool for critical literature appraisal that overcomes several barriers to traditional journal club participations while fostering connectedness within the global ID community.
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Affiliation(s)
- Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Todd McCarty
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Laila E Woc-Colburn
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - James B Cutrell
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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31
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Titanji BK, Tejani M, Farber EW, Mehta CC, Pace TW, Meagley K, Gavegnano C, Harrison T, Kokubun CW, Negi SD, Schinazi RF, Marconi VC. Cognitively Based Compassion Training for HIV Immune Nonresponders-An Attention-Placebo Randomized Controlled Trial. J Acquir Immune Defic Syndr 2022; 89:340-348. [PMID: 34879006 PMCID: PMC8837678 DOI: 10.1097/qai.0000000000002874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Chronic inflammation is associated with increased morbidity and mortality for people with HIV (PWH). Psychological stress is an important contributor to this chronic inflammation. We hypothesized that a cognitively based compassion training (CBCT) approach could reduce inflammation and psychological stress in immune nonresponder PWH. DESIGN An attention-placebo randomized controlled trial design to evaluate the acceptability of CBCT among PWH and its effects on key aspects of stress and immune function compared with an active-attention control group (NCT02395289). METHODS This study was conducted at an HIV clinic in Atlanta, Georgia. Eligible individuals determined by (1) adherence to antiretroviral therapy for at least a year, (2) virologic suppression; and (3) stable CD4+ T-cell counts <350 cells/μL were randomized in a 2:1 ratio to either CBCT or control in 2 study periods: April-May, 2016, and September-December, 2016. Psychological measures and inflammatory biomarkers associated with HIV disease progression (IL-1β, TNF-α, sCD14, IL-6, and IL-10) were obtained for all study participants at baseline and at the time of study completion. RESULTS We found a significant association between CBCT practice time engagement and fold reduction in IL-6 and TNF-α levels. There was no association between CBCT practice time and other biomarkers markers assessed (IL-1β, sCD14, and IL-10). These changes were coincident with significant increases in self-reported psychological well-being and HIV disease acceptance and in benefits for CBCT participants. We also observed fewer instances of virologic failure for those in the CBCT arm compared with controls. CONCLUSIONS CBCT is a novel and feasible nonmedication-based intervention that could reduce inflammation and psychological stress in PWH.
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Affiliation(s)
- Boghuma K. Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Mehul Tejani
- Division of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Eugene W. Farber
- Emory University School of Medicine Department of Psychiatry and Behavioral Sciences, Atlanta, GA
| | - C. Christina Mehta
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta GA
| | - Thaddeus W. Pace
- Community and Systems Health Science Division, University of Arizona, Tuscon, AZ
| | - Kathryn Meagley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Christina Gavegnano
- Department of Pathology and Laboratory Medicine, Emory School of Medicine, Atlanta, GA
| | - Timothy Harrison
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Caroline W. Kokubun
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Satya Dev Negi
- Center for Contemplative Science and Compassion-Based Ethics, Emory University, Atlanta, GA
| | - Raymond F. Schinazi
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA
| | - Vincent C. Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA
- Department of Global Health, Rollins School of Public Health, Emory University Atlanta
- Emory Vaccine Center, Emory University, Atlanta, GA
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32
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Titanji BK, Gwinn M, Marconi VC, Sun YV. Epigenome-wide epidemiologic studies of human immunodeficiency virus infection, treatment, and disease progression. Clin Epigenetics 2022; 14:8. [PMID: 35016709 PMCID: PMC8750639 DOI: 10.1186/s13148-022-01230-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/06/2022] [Indexed: 12/12/2022] Open
Abstract
Despite significant advances in the treatment and care of people with HIV (PWH), several challenges remain in our understanding of disease pathogenesis to improve patient care. HIV infection can modify the host epigenome and as such can impact disease progression, as well as the molecular processes driving non-AIDS comorbidities in PWH. Epigenetic epidemiologic studies including epigenome-wide association studies (EWAS) offer a unique set of tools to expand our understanding of HIV disease and to identify novel strategies applicable to treatment and diagnosis in this patient population. In this review, we summarize the current state of knowledge from epigenetic epidemiologic studies of PWH, identify the main challenges of this approach, and highlight future directions for the field. Emerging epigenetic epidemiologic studies of PWH can expand our understanding of HIV infection and health outcomes, improve scientific validity through collaboration and replication, and increase the coverage of diverse populations affected by the global HIV pandemic. Through this review, we hope to highlight the potential of EWAS as a tool for HIV research and to engage more investigators to explore its application to important research questions.
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Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Marta Gwinn
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE #3049, Atlanta, GA, 30322, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA.,Atlanta Veterans Affairs Health Care System, Decatur, GA, USA.,Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA.,Emory Vaccine Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE #3049, Atlanta, GA, 30322, USA. .,Atlanta Veterans Affairs Health Care System, Decatur, GA, USA.
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33
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Titanji BK, Farley MM, Schinazi RF, Marconi VC. Response to Correspondence: Baricitinib: Impact on Coronavirus Disease 2019 (COVID-19) Coagulopathy? Jorgensen et al. Clin Infect Dis 2021; 73:e3980-e3981. [PMID: 32797226 PMCID: PMC7454400 DOI: 10.1093/cid/ciaa1210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
| | - Monica M Farley
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
- Infectious Diseases, Atlanta Veterans Affairs Medical Center,
Decatur, Georgia, USA
| | - Raymond F Schinazi
- Department of Pediatrics, Emory University School of Medicine,
Atlanta, Georgia, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
- Infectious Diseases, Atlanta Veterans Affairs Medical Center,
Decatur, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public
Health, Atlanta, Georgia, USA
- The Emory Vaccine Center, Atlanta, Georgia, USA
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34
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Titanji BK, Farley MM, Schinazi RF, Marconi VC. Reply to Jorgensen, et al. Clin Infect Dis 2021; 73:e3978-e3979. [PMID: 32797235 PMCID: PMC7454319 DOI: 10.1093/cid/ciaa1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
| | - Monica M Farley
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
- Infectious Diseases, Atlanta Veterans Affairs Medical Center,
Decatur, Georgia, USA
| | - Raymond F Schinazi
- Department of Pediatrics, Emory University School of Medicine,
Atlanta, Georgia, USA
| | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of
Medicine, Atlanta, Georgia, USA
- Infectious Diseases, Atlanta Veterans Affairs Medical Center,
Decatur, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public
Health, Atlanta, Georgia, USA
- The Emory Vaccine Center, Atlanta,
Georgia, USA
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35
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Abstract
Translational research plays a pivotal role in leveraging good science to serve humanity. Structural racism and a lack of diversity severely limit our potential as scientists to exert a maximum impact. This moment calls for a renewed commitment to ridding science of racism and bias and promoting diversity, which makes us more effective at innovating and delivering therapeutics to the patients we serve.
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Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Talia H Swartz
- Division of Infectious Diseases, Department of Medicine, Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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36
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Titanji BK, Farley MM, Mehta A, Connor-Schuler R, Moanna A, Cribbs SK, O'Shea J, DeSilva K, Chan B, Edwards A, Gavegnano C, Schinazi RF, Marconi VC. Use of Baricitinib in Patients With Moderate to Severe Coronavirus Disease 2019. Clin Infect Dis 2021; 72:1247-1250. [PMID: 32597466 PMCID: PMC7337637 DOI: 10.1093/cid/ciaa879] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/22/2020] [Indexed: 01/08/2023] Open
Abstract
Hyperinflammation is associated with increased mortality in coronavirus disease 2019 (COVID-19). In this retrospective, uncontrolled patient cohort with moderate -severe COVID-19, treatment with baricitinib plus hydroxychloroquine was associated with recovery in 11 of 15 patients. Baricitinib for the treatment of COVID-19 should be further investigated in randomized, controlled clinical trials.
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Affiliation(s)
- Boghuma K Titanji
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Monica M Farley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Infectious Diseases, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Ashish Mehta
- Pulmonary Medicine, Atlanta Veterans Affairs Medical Center, Department of Medicine, Decatur, Georgia, USA.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia, USA
| | - Randi Connor-Schuler
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia, USA
| | - Abeer Moanna
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Infectious Diseases, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Sushma K Cribbs
- Pulmonary Medicine, Atlanta Veterans Affairs Medical Center, Department of Medicine, Decatur, Georgia, USA.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University, Atlanta, Georgia, USA
| | - Jesse O'Shea
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kathryn DeSilva
- Infectious Diseases, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Bonnie Chan
- Infectious Diseases, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Alex Edwards
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Christina Gavegnano
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Vincent C Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.,Infectious Diseases, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.,Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
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