Daily TDF-FTC prophylaxis prevented HIV infection in sexually active heterosexual adults. The long-term safety of daily TDF-FTC prophylaxis, including the effect on bone mineral density, remains unknown. (Funded by the Centers for Disease Control and Prevention and the National Institutes of Health; TDF2 ClinicalTrials.gov number, NCT00448669.).

Objective A recent HIV outbreak in a rural network of persons who inject drugs (PWID) underscored the intersection of the expanding epidemics of opioid abuse, injection drug use (IDU), and associated increases in hepatitis C virus (HCV) infections. We sought to identify U.S. communities especially vulnerable to rapid spread of IDU-associated HIV, if introduced, and new or continuing high rates of HCV infections. Design We conducted a multi-step analysis to identify which indicator variables were highly associated with IDU. We then used these indicator values to calculate vulnerability scores for each county to identify which were most vulnerable. Methods We used confirmed cases of acute HCV infection reported to the National Notifiable Disease Surveillance System, 2012–2013, as a proxy outcome for IDU, and 15 county-level indicators available nationally in Poisson regression models to identify indicators associated with higher county acute HCV infection rates. Using these indicators, we calculated composite index scores to rank each county’s vulnerability. Results A parsimonious set of six indicators were associated with acute HCV infection rates (proxy for IDU): drug overdose deaths, prescription opioid sales, per capita income, white, non-Hispanic race/ethnicity, unemployment, and buprenorphine prescribing potential by waiver. Based on these indicators, we identified 220 counties in 26 states within the 95th percentile of most vulnerable. Conclusions Our analysis highlights U.S. counties potentially vulnerable to HIV and HCV infections among PWID in the context of the national opioid epidemic. State and local health departments will need to further explore vulnerability and target interventions to prevent transmission.

Chemokines and their receptors such as CCR2 and CX3CR1 mediate leukocyte adhesion and migration into injured tissue. To further define mechanisms of monocyte trafficking during kidney injury we identified two groups of F4/80-positive cells (F4/80low and F4/80high) in the normal mouse kidney that phenotypically correspond to macrophages and dendritic cells, respectively. Following ischemia and 3 h of reperfusion, there was a large influx of F4/80low inflamed monocytes, but not dendritic cells, into the kidney. These monocytes produced TNF-α, IL-6, IL-1 α and IL-12. Ischemic injury induced in CCR2−/− mice or in CCR2+/+ mice, made chimeric with CCR2−/− bone marrow, resulted in lower plasma creatinine levels and their kidneys had fewer infiltrated F4/80low macrophages compared to control mice. CX3CR1 expression contributed to monocyte recruitment into inflamed kidneys, as ischemic injury in CX3CR1−/− mice was reduced, with fewer F4/80low macrophages than controls. Monocytes transferred from CCR2+/+ or CX3CR1+/− mice migrated into reperfused kidneys better than monocytes from either CCR2−/− or CX3CR1−/− mice. Adoptive transfer of monocytes from CCR2+/+ mice, but not CCR2−/− mice, reversed the protective effect in CCR2−/− mice following ischemia-reperfusion. Egress of CD11b+Ly6Chigh monocytes from blood into inflamed kidneys was CCR2- and CX3CR1-dependent. Our study shows that inflamed monocyte migration, through CCR2- and CX3CR1-dependent mechanisms, plays a critical role in kidney injury following ischemia reperfusion.

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