No abstract

Hepatitis B (HBV) and hepatitis C (HCV) co-infection are increasingly important sources of morbidity among HIV-infected persons. We determined associations between hepatitis co-infection and healthcare utilization among HIV-infected adults at four U.S. sites during 2006–2011. Outpatient HIV visits did not differ by hepatitis serostatus and decreased over time. Mental health visits were more common among HIV/HCV co-infected persons than among HIV mono-infected (IRR 1.27 [1.08–1.50]). Hospitalization rates were higher among all hepatitis-infected groups than among HIV mono-infected (HIV/HBV IRR 1.23 [1.05–1.44], HIV/HCV 1.22 [1.10–1.36], HIV/HBV/HCV 1.31 [1.02–1.68]). These findings may inform the design of clinical services and allocation of resources.

Disseminated nontuberculous mycobacterial infections should always prompt immune evaluation. This first case of disseminated nontuberculous mycobacterial infection and anti-IFNγ autoantibodies in an American-born Caucasian suggests that anti-cytokine autoantibodies are not racially or regionally restricted.

Background Accurate and timely methods for the diagnosis of histoplasmosis in resource limited countries are lacking. Histoplasma antigen detection by enzyme immunoassay (EIA) is widely used in the US but not in resource limited countries, leading to missed or delayed diagnoses and poor outcomes. Lateral flow assays (LFA) can be used in this setting. Methods Frozen urine specimens were submitted to MiraVista diagnostics for antigen testing from three medical centers in endemic areas of the US. They were blinded and tested for the MVista Histoplasma LFA. Patients were classified as controls or cases of histoplasmosis. Cases were divided into proven or probable, pulmonary or disseminated, immunocompetent or immunosuppressed, and mild, moderate, or severe. Results 352 subjects were enrolled, including 66 cases (44 proven, 22 probable) and 286 controls. Most of the cases were immunocompromised (71%),46 had disseminated and 20 had pulmonary histoplasmosis. Four were mild, 42 moderate, and 20 severe. LFA and EIA were highly concordant (kappa 0.84). Sensitivity and specificity of the LFA were 78.8% and 99.3% respectively. LFA sensitivity was higher in proven cases (93.2%), patient with disseminated (91.3%), moderate (78.6%) and severe disease (80%), and those with galactomannan levels > 1.8 ng/mL (97.8%). Specificity was 99.3% in proven cases, 99.3% in patient with moderate/severe disease, and 96.8% in those with galactomannan levels > 1.8 ng/mL. Cross reactivity was noted with other endemic mycoses. Conclusion The MVista Histoplasma LFA meets the need for accurate rapid diagnosis of histoplasmosis in resource limited countries, especially in patient with high disease burden, potentially reducing morbidity and mortality.