Tobacco, alcohol, cannabis, and illicit drug use and their association with CD4/CD8 cell count ratio in people with controlled HIV: a cross-sectional study (ANRS CO3 AQUIVIH-NA-QuAliV)

BACKGROUND

To evaluate drug use (alcohol, tobacco, cannabis and other drugs) and its association with mean CD4/CD8 T cell count ratio, a marker of chronic inflammation, in virally suppressed people living with HIV-1 (PLWH) in Nouvelle Aquitaine, France.

METHODS

A multi-centric, cross-sectional analysis was conducted in 2018-19 in the QuAliV study-ANRS CO3 AQUIVIH-NA cohort. Tobacco, alcohol, cannabis, and other drug use (poppers, cocaine, amphetamines, synthetic cathinones, GHB/GBL) were self-reported. CD4 and CD8 T cell counts and viral load measures, ± 2 years of self-report, and other characteristics were abstracted from medical records. Univariable and multivariable linear regression models, adjusted for age, sex, HIV risk group, time since HIV diagnosis, and other drug use were fit for each drug and most recent CD4/CD8 ratio.

RESULTS

660 PLWH, aged 54.7 ± 11.2, were included. 47.7% [315/660] had a CD4/CD8 ratio of < 1. Their mean CD4/CD8 ratio was 1.1 ± 0.6. 35% smoked; ~ 40% were considered to be hazardous drinkers or have alcohol use disorder; 19.9% used cannabis and 11.9% other drugs. Chemsex-associated drug users' CD4/CD8 ratio was on average 0.226 (95% confidence interval [95% CI] - 0.383, - 0.070) lower than that of non-users in univariable analysis (p = 0.005) and 0.165 lower [95% CI - 0.343, 0.012] in multivariable analysis (p = 0.068).

CONCLUSIONS

Mean differences in CD4/CD8 ratio were not significantly different in tobacco, alcohol and cannabis users compared to non-users. However, Chemsex-associated drug users may represent a population at risk of chronic inflammation, the specific determinants of which merit further investigation.

TRIAL REGISTRATION NUMBER

NCT03296202.

Severe bacterial non-AIDS infections in persons with HIV: the epidemiology and evolution of antibiotic resistance over an 18-year period (2000-2017) in the ANRS CO3 AquiVih-Nouvelle-Aquitaine cohort

BACKGROUND

Severe non-AIDS bacterial infections (SBIs) are one of the leading causes of hospital admissions among persons with HIV (PWH) in regions with high ART coverage.

METHODS

This large prospective cohort study of PWH examined the types of infections, bacterial documentation, and evolution of antibiotic resistance among PWH hospitalized with SBIs over an 18-year period.

RESULTS

Between 2000 and 2017, 459 PWH had at least one SBI with bacterial documentation. Among the 847 SBIs, there were 280 cases of bacteremia, 269 cases of pneumonia, and 240 urinary tract infections. The 1025 isolated bacteria included Enterobacteriaceae (n = 394; mainly Escherichia coli), Staphylococcus aureus (n = 153) and Streptococcus pneumoniae (n = 82). The proportion of S. pneumoniae as the causative agent in pneumonia and bacteremia decreased sharply over time, from 34% to 8% and from 21 to 3%, respectively.The overall antibiotic resistance of S. aureus and S. pneumoniae decreased progressively but it increased for Enterobacteriaceae (from 24% to 48% for amoxicillin-clavulanate, from 4 to 18% for cefotaxime, and from 5% to 27% for ciprofloxacin). Cotrimoxazole prophylaxis was associated with higher nonsusceptibility of S. pneumoniae to amoxicillin and erythromycin, higher nonsusceptibility of Enterobacteriaceae to beta-lactams and fluoroquinolones, and a higher risk of extended-spectrum β-lactamase producing Enterobacteriaceae.

CONCLUSIONS

The bacterial resistance pattern among PWH between 2014 and 2017 was broadly similar to that in the general population, with the exception of a higher resistance profile of Enterobacteriaceae to fluoroquinolones. The use of cotrimoxazole as prophylaxis was associated with an increased risk of antibiotic resistance.

Hydrocephalus and vasculitis delay therapeutic responses in tuberculous meninigitis: Results of Haydarpasa-III study

AIMS

There is no report on the factors affecting the resolution of symptoms related to meningitis during treatment of tuberculous meningitis (TBM). Thus, we examined the factors associated with early therapeutic responses.

MATERIALS AND METHODS

This multicenter study included 507 patients with microbiologically confirmed TBM. However, 94 patients eligible for the analysis were included in this study from 24 centers. Six out of 94 patients died and the statistical analysis was performed with 88 survivors. Early and late responder groups were compared in the statistical analysis. P < 0.05 were considered to show a significant difference.

RESULTS

In the multivariate analysis, the presence of vasculitis (P = 0.029, OR = 10.491 [95% CI, 1.27-86.83]) was found to be significantly associated with a delayed fever response whereas hydrocephalus was associated with altered mental status for >9 days duration (P = 0.005, OR = 5.740 [95% CI, 1.68-19.57]). According to linear regression analysis, fever was significantly persisting (>7 days) in the presence of vasculitis (17.5 vs. 7, P< 0.001) and hydrocephalus (11 vs. 7, P = 0.029). Hydrocephalus was significantly associated with persisting headache (21 vs. 12, P = 0.025), delayed recovery of consciousness (19.5 vs. 7, P = 0.001), and a delay in complete recovery (21 vs. 14, P = 0.007) in the linear regression analysis. Following institution of treatment, the complaints seemed to disappear in up to 2 weeks among TBM survivors.

CONCLUSIONS

In the absence of hydrocephalus or vasculitis, one week of anti-tuberculosis treatment seems to be adequate for the resolution of TBM symptoms. Hydrocephalus and vasculitis delay the resolution of TBM symptoms in response to antimycobacterial treatment.

Antituberculosis drug resistance patterns in adults with tuberculous meningitis: results of haydarpasa-iv study

Background

Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM.

Methods

Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB).

Results

Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any first-line drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38–6.82) and 2.14 (95 % CI, 0:34–13:42), respectively.

Conclusion

INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing.

Feasibility studies: UV/chlorine advanced oxidation treatment for the removal of emerging contaminants

UV/chlorine (UV/HOCl and UV/ClO(2)) Advanced Oxidation Processes (AOPs) were assessed with varying process layout and compared to the state of the art UV/H(2)O(2) AOP. The process comparison focused on the economical and energy saving potential of the UV/chlorine AOP. Therefore the experiments were performed at technical scale (250 L/h continuous flow reactor) and at process energies, oxidant and model contaminant concentrations expected in full scale reference plants. As model compounds the emerging contaminants (ECs): desethylatrazine, sulfamethoxazole, carbamazepine, diclofenac, benzotriazole, tolyltriazole, iopamidole and 17α-ethinylestradiol (EE2) were degraded at initial compound concentrations of 1 μg/L in tap water and matrixes with increased organic load (46 mg/L DOC). UV/chlorine AOP organic by-product forming potential was assessed for trihalomethanes (THMs) and N-Nitrosodimethylamine (NDMA). A process design was evaluated which can considerably reduce process costs, energy consumption and by-product generation from UV/HOCl AOPs.

Grading student clinical practice performance: the Australian perspective

Educators have long considered assigning a grade in the assessment of student clinical practice performance as too variable, too subjective, or educationally inappropriate. Consequently, most undergraduate nurse education programs have maintained non-graded pass/fail criteria assessment for evaluating and reporting student clinical performance. This paper argues that, while the varied clinical environments do make assessing students' clinical performance difficult, the reliability and validity of assessment practices should be maintained no matter what the grading system. Furthermore, many assumptions about criterion-referenced assessment, and the associated preclusion of graded assessment, are seen to be baseless when dealing with competencies rather than with traditional behavioural objectives. By combining both criterion-referenced and norm-referenced assessment, graded assessment can clarify and impress on students the minimal competency requirements, while at the same time describing and rewarding meritorious practice. It is argued that to do so would provide a more appropriate way of communicating the assessment of theory application in praxis, a highly relevant issue in a practice-based discipline such as nursing. It is now appropriate to reconsider the debate of graded student clinical performance assessments, and to investigate both the practicalities and benefits of this approach.

Role of alcohol and tobacco in the aetiology of head and neck cancer: a case-control study in the Doubs region of France

A case-control study conducted from 1986 to 1989 using the Doubs Cancer Registry included 299 cases of head and neck cancer and 645 controls from the general population. The results provide an indicator of the respective roles of alcohol and tobacco in all these cancers and on the tumour site. The people who smoked more than one packet of cigarettes a day have a risk that is 13 times higher than that of non-smokers and those who drink more than one and a half litres of wine per day have a risk that is 34 times higher of developing head and neck cancer. The combined exposure of alcohol and tobacco is characterised by a high risk and can be described by a multiplicative model without interaction. The age at onset (below 18 years of age) and the duration of smoking (over 35 years) are high risk factors. The risk decreases after stopping smoking, but only casual smokers (less than 7 cigarettes per day) can hope to have the same risk as non-smokers within a period of 15 years. Subjects smoking only non-filter cigarettes have a higher risk (OR = 1.98) than those who smoke filter cigarettes. The same applies to those who roll their own cigarettes (OR = 1.93) or inhale the smoke (OR = 1.51).