Browsing by Author "Gill, John"

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    Acute HIV infection presenting as hemophagocytic lymphohistiocytosis: case report and review of the literature
    (2017-09-20) Manji, Farheen; Wilson, Evan; Mahe, Etienne; Gill, John; Conly, John
    Abstract Background Hemophagocytic lymphohistiocytosis (HLH) is an uncommon systemic inflammatory condition that can result from infections, autoimmune diseases and malignancies. It is a rarely reported life threatening complication of an acute HIV infection, with only ten documented case reports per our literature search. We present a case of HLH secondary to acute HIV infection with a negative HIV antibody-based assay and high plasma viral load. Case presentation A 45 year old male with a past medical history of well controlled hypertension presented with fever, dizziness and non-bloody diarrhea. Initial lab work revealed a new thrombocytopenia, marked renal failure and an elevated creatine kinase, ferritin, lactate dehydrogenase and D-dimer. A bone marrow biopsy revealed HLH. As part of the work up for thrombocytopenia, a rapid HIV antibody based assay was done and was negative. The sample was later routinely tested with a fourth generation antigen/antibody assay as per local protocol and was strongly positive. The plasma RNA viral load was >10,000,000 copies /mL confirming the diagnosis of an acute HIV infection. The patient was urgently started on antiretroviral therapy and recovered. Conclusion This case illustrates a diagnostic approach to HLH which is an uncommon but life threatening multisystem disease, requiring the involvement of a multidisciplinary team of experts. Following any diagnosis of HLH, rapid identification and treatment of the underlying condition is critical. A negative rapid HIV antibody test can be misleading in the context of early HIV infection and the additional use of fourth generation antigen/antibody test or plasma RNA viral load may be required within the right clinical context for diagnosis.
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    HIV-1 molecular transmission clusters in nine European countries and Canada: association with demographic and clinical factors
    (2019-01-08) Paraskevis, Dimitrios; Beloukas, Apostolos; Stasinos, Kostantinos; Pantazis, Nikos; de Mendoza, Carmen; Bannert, Norbert; Meyer, Laurence; Zangerle, Robert; Gill, John; Prins, Maria; d’Arminio Montforte, Antonella; Kran, Anne-Marte B; Porter, Kholoud; Touloumi, Giota
    Abstract Background Knowledge of HIV-1 molecular transmission clusters (MTCs) is important, especially in large-scale datasets, for designing prevention programmes and public health intervention strategies. We used a large-scale HIV-1 sequence dataset from nine European HIV cohorts and one Canadian, to identify MTCs and investigate factors associated with the probability of belonging to MTCs. Methods To identify MTCs, we applied maximum likelihood inferences on partial pol sequences from 8955 HIV-positive individuals linked to demographic and clinical data. MTCs were defined using two different criteria: clusters with bootstrap support >75% (phylogenetic confidence criterion) and clusters consisting of sequences from a specific region at a proportion of >75% (geographic criterion) compared to the total number of sequences within the network. Multivariable logistic regression analysis was used to assess factors associated with MTC clustering. Results Although 3700 (41%) sequences belonged to MTCs, proportions differed substantially by country and subtype, ranging from 7% among UK subtype C sequences to 63% among German subtype B sequences. The probability of belonging to an MTC was independently less likely for women than men (OR = 0.66; P < 0.001), older individuals (OR = 0.79 per 10-year increase in age; P < 0.001) and people of non-white ethnicity (OR = 0.44; P < 0.001 and OR = 0.70; P = 0.002 for black and ‘other’ versus white, respectively). It was also more likely among men who have sex with men (MSM) than other risk groups (OR = 0.62; P < 0.001 and OR = 0.69; P = 0.002 for people who inject drugs, and sex between men and women, respectively), subtype B (ORs 0.36–0.70 for A, C, CRF01 and CRF02 versus B; all P < 0.05), having a well-estimated date of seroconversion (OR = 1.44; P < 0.001), a later calendar year of sampling (ORs 2.01–2.61 for all post-2002 periods versus pre-2002; all P < 0.01), and being naïve to antiretroviral therapy at sampling (OR = 1.19; P = 0.010). Conclusions A high proportion (>40%) of individuals belonged to MTCs. Notably, the HIV epidemic dispersal appears to be driven by subtype B viruses spread within MSM networks. Expansion of regional epidemics seems mainly associated with recent MTCs, rather than the growth of older, established ones. This information is important for designing prevention and public health intervention strategies.
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    Hospitalization for Community-Acquired Pneumonia in Alberta Patients with Human Immunodeficiency Virus Infection: A Case Control Study
    (2003-01-01) Johnson, David H; Carriere, Keumhee C; Houston, Stan; Jin, Yan; Predy, Gerry; Gill, John; Shafran, Stephen; Marrie, Thomas J
    BACKGROUND: To determine whether outcomes of pneumonia among human immunodeficiency virus (HIV)-positive persons differed from those among HIV-negative persons.METHODS: Alberta hospital patient abstracts for HIV-positive persons requiring hospitalization for pneumonia from April 1, 1994, until March 31, 1999, were matched by age and sex with four HIV-negative counterparts.RESULTS: Hospitalizations for community-acquired pneumonia decreased for those with HIV (acquired immunodeficiency syndrome [AIDS]) and increased for those with HIV (non-AIDS) during the study period. HIV (AIDS) patients admitted for community-acquired pneumonia (n=130) manifested three times higher odds for a longer length of hospital stay and had three and 10 times higher odds for excess in-hospital and one-year mortality, respectively, than their matched controls. Similarly, HIV (non-AIDS) patients admitted for community-acquired pneumonia (n=46) manifested two times higher odds for a longer length of hospital stay and had four times higher odds for excess one-year mortality than their matched controls. The in-hospital and one-year mortality rates for the HIV (AIDS) patients were 21.2% and 64.3%, respectively, during the first three years, and decreased to 8.7% and 40.7%, respectively, in the last two years of the study.CONCLUSIONS: The outcomes for community-acquired pneumonia were worse for those with HIV (non-AIDS) and HIV (AIDS) compared with non-HIV hospitalized patients matched for age and sex, and controlling for severity of illness and comorbidity. In-hospital and one-year mortality rates for patients with HIV (AIDS) showed a marked decline over the study period.