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Hackman J, Falade-Nwulia O, Mehta S, Downing Z, Kirk G, Ray S, Thomas D, Laeyendecker O. A23 Population level diversification of hepatitis C viral strains over time among people who inject drugs in Baltimore, MD. Virus Evol 2019. [PMCID: PMC6736091 DOI: 10.1093/ve/vez002.022] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Hepatitis C virus (HCV) infection occurs in 30–90 per cent of people who inject drugs (PWID). Although cure rates can exceed 95 per cent, treatment access is limited and approximately 400,000 people die each year due to complications of chronic infection. A temporal analysis of cluster networks among PWID can be used to inform strategies to interdict transmission. In Baltimore, PWID have been recruited for The AIDS Linked to the IntraVenous Experience (ALIVE) cohort. A demographic questionnaire was administered and recorded for baseline and recent participants. Viral RNA underwent PCR with primers targeting the core and envelope-1 protein (CE1) and sequenced via Sanger sequencing. Sequences with > 400 bp reads and Q-scores >370 were used for downstream analysis resulting in 322 ALIVE baseline participants (1988–9) and 548 recently diagnosed subjects enrolled approximately two decades later (2005–16). Cluster networks were rendered with a threshold of 4 per cent in MicrobeTRACE, and statistical analyses were performed in R Studio. Of the 1988–9 subjects, the majority (259/317, 81.7%) were a part of cluster. There were nine clusters and fifty-eight singletons, with two large clusters containing most sequences of genotype 1a (73.5%). Two decades later, a minority of recently diagnosed individuals (235/512, 44.1%) were part of a cluster. There were seventeen clusters with 286 singletons with two large clusters containing 1a genotype individuals (21.5%). Additional clustering was done by parsing the two datasets by subtype 1a (n = 714) and 1b (n = 151). The genotype 1a network demonstrates a majority, 65.8 per cent, of participants in clusters. Moreover, two large clusters can be observed with baseline participants towards the center and recent participants on the outskirts indicative of high linkage at baseline. The genotype 1b network produced a single large cluster but subclusters were observed. The sequences between the two time points co-mingled but subclusters were also observed. Interestingly, the two large clusters from 1988 to 1989 were still evident in the 2005–16 viral sequences. We observed greater cluster diversity in more recently diagnosed individuals, indicative of a less connected network of individuals sharing transmission risk, though major viral strains did persist over time in this cohort.
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Affiliation(s)
- J Hackman
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - O Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Mehta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Z Downing
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Kirk
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Ray
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Thomas
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O Laeyendecker
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Stea B, Shaw E, Pintér T, Hackman J, Craig M, May J, Steffen RP, Suh JH. Efaproxiral red blood cell concentration predicts efficacy in patients with brain metastases. Br J Cancer 2006; 94:1777-84. [PMID: 16773073 PMCID: PMC2361352 DOI: 10.1038/sj.bjc.6603169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Efaproxiral (Efaproxyn™, RSR13), a synthetic allosteric modifier of haemoglobin (Hb), decreases Hb-oxygen (O2) binding affinity and enhances oxygenation of hypoxic tumours during radiation therapy. This analysis evaluated the Phase 3, Radiation Enhancing Allosteric Compound for Hypoxic Brain Metastases; RT-009 (REACH) study efficacy results in relation to efaproxiral exposure (efaproxiral red blood cell concentration (E-RBC) and number of doses). Recursive partitioning analysis Class I or II patients with brain metastases from solid tumours received standard whole-brain radiation therapy (3 Gy/fraction × 10 days), plus supplemental O2 (4 l/min), either with efaproxiral (75 or 100 mg/kg daily) or without (control). Efaproxiral red blood cell concentrations were linearly extrapolated to all efaproxiral doses received. Three patient populations were analysed: (1) all eligible, (2) non-small-cell lung cancer (NSCLC) as primary cancer, and (3) breast cancer primary. Efficacy endpoints were survival and response rate. Brain metastases patients achieving sufficient E-RBC (⩾483 μg/ml) and receiving at least seven of 10 efaproxiral doses were most likely to experience survival and response benefits. Patients with breast cancer primary tumours generally achieved the target efaproxiral exposure and therefore gained greater benefit from efaproxiral treatment than NSCLC patients. This analysis defined the efaproxiral concentration-dependence in survival and response rate improvement, and provided a clearer understanding of efaproxiral dosing requirements.
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Affiliation(s)
- B Stea
- Department of Radiation Oncology, The University of Arizona Health Sciences Center, Tucson, 85724, USA.
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Shaw E, Stea B, Pinter T, Hammoud Y, Cagnoni PJ, Hackman J, Boyd A, Craig M, Marks J, Suh J. Pharmacokinetics (PK) of RSR13 (efaproxiral) predict survival in patients with brain metastases randomized to receive whole brain radiation therapy (WBRT) with or without RSR13 (REACH RT-009). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.1561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Shaw
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - B. Stea
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - T. Pinter
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - Y. Hammoud
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - P. J. Cagnoni
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - J. Hackman
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - A. Boyd
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - M. Craig
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - J. Marks
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
| | - J. Suh
- Wake Forest University School of Medicine, Winston-Salem, NC; University of Arizona Health, Tucson, AZ; Petz Aladar Hospital of Gyor-Moson, Gyor, Hungary; Hopital de Montbéliard, Montbéliard, France; Allos Therapeutics, Inc, Westminster, CO; Cleveland Clinic, Cleveland, OH
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Sterling TR, Dorman SE, Chaisson RE, Ding L, Hackman J, Moore K, Holland SM. Human immunodeficiency virus-seronegative adults with extrapulmonary tuberculosis have abnormal innate immune responses. Clin Infect Dis 2001; 33:976-82. [PMID: 11528568 DOI: 10.1086/322670] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2000] [Revised: 02/13/2001] [Indexed: 11/03/2022] Open
Abstract
Extrapulmonary tuberculosis is presumably a marker of underlying immunodeficiency, but cytokine response pathways in these patients have not been well studied. Cytokine responses of peripheral blood mononuclear cells from human immunodeficiency virus-seronegative adults with prior culture-confirmed extrapulmonary tuberculosis were compared with those of persons with latent Mycobacterium tuberculosis infection. Mitogen-stimulated interferon (IFN)-gamma production, interleukin (IL)-12 production, and IFN-gamma receptor- and IL-12 receptor-mediated cytokine production did not differ between case patients and control patients. However, median resting IL-8 production was significantly lower in case patients than control patients (8051 vs. 19,290 pg/mL; P=.009). In addition, the median tumor necrosis factor (TNF)-alpha response was lower in case patients than control patients after stimulation with lipopolysaccharide (833 vs. 1149 pg/mL; P=.06) and lipopolysaccharide plus IFN-gamma (3301 vs. 4411 pg/mL; P=.04). These abnormalities in resting IL-8 and lipopolysaccharide-induced TNF-alpha production were not associated with IFN-gamma or IL-12 abnormalities and were detected up to several years after cure of disease, suggesting an abnormality in innate immunity.
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Affiliation(s)
- T R Sterling
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Chaisson RE, Barnes GL, Hackman J, Watkinson L, Kimbrough L, Metha S, Cavalcante S, Moore RD. A randomized, controlled trial of interventions to improve adherence to isoniazid therapy to prevent tuberculosis in injection drug users. Am J Med 2001; 110:610-5. [PMID: 11382368 DOI: 10.1016/s0002-9343(01)00695-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the effect of several interventions on adherence to tuberculosis preventive therapy. METHODS We conducted a randomized trial with a factorial design comparing strategies for improving adherence to isoniazid preventive therapy in 300 injection drug users with reactive tuberculin tests and no evidence of active tuberculosis. Patients were assigned to receive directly observed isoniazid preventive therapy twice weekly (Supervised group, n = 99), daily self-administered isoniazid with peer counseling and education (Peer group, n = 101), or routine care (Routine group, n = 100). Patients within each arm were also randomly assigned to receive an immediate or deferred monthly $10 stipend for maintaining adherence. The endpoints of the trial were completing 6 months of treatment, pill-taking as measured by self-report or observation, isoniazid metabolites present in urine, and bottle opening as determined by electronic monitors in a subset of patients. RESULTS Completion of therapy was 80% for patients in the Supervised group, 78% in the Peer group, and 79% in the Routine group (P = 0.70). Completion was 83% (125 of 150) among patients receiving immediate incentives versus 75% (112 of 150) among patients with deferred incentives (P = 0.09). The proportion of patients who were observed or reported taking at least 80% of their doses was 82% for the Supervised arm of the study, compared with 71% for the Peer arm and 90% for the Routine arm. The proportion of patients who took 100% of doses was 77% for the Supervised arm (by observation), 6% for the Peer arm (by report), and 10% for the Routine arm (by report; P <0.001). Direct observation showed the median proportion of doses taken by the Supervised group was 100%, while electronic monitoring in a subset of patients showed the Peer group (n = 27) took 57% of prescribed doses and the Routine group (n = 32) took 49% (P <0.001). Patients in the Routine arm overreported adherence by twofold when data from electronic monitoring were used as a gold standard. There were no significant differences in electronically monitored adherence by type of incentive. CONCLUSION Adherence to isoniazid preventive therapy by injection drug users is best with supervised care. Peer counseling improves adherence over routine care, as measured by electronic monitoring of pill caps, and patients receiving peer counseling more accurately reported their adherence. More widespread use of supervised care could contribute to reductions in tuberculosis rates among drug users and possibly other high-risk groups.
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Affiliation(s)
- R E Chaisson
- Center for Tuberculosis Research, Johns Hopkins University, and the Baltimore City Health Department, Baltimore, Maryland 21231-1001, USA
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