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Persistent inflammation in HIV infection is associated with elevated cardiovascular disease risk, even with viral suppression. Identification of novel surrogate biomarkers can enhance cardiovascular disease risk stratification and suggest novel therapies. We investigated the potential of IL-32, a proinflammatory multi-isoform cytokine, as a biomarker for subclinical carotid artery atherosclerosis in virologically-suppressed women living with HIV (WLWH).

Nested within the Women's Interagency HIV Study (WIHS), we conducted a cross-sectional comparison of IL-32 between 399 WLWH and 100 women without HIV, followed by a case-control study of 72 WLWH (36 carotid artery plaque cases vs. 36 age-matched controls without plaque). Plasma IL-32 protein was measured by ELISA, and mRNA of IL-32 isoforms (IL-32α, β, γ, D, ε, θ) was quantified by RT-PCR from peripheral blood mononuclear cells (PBMCs). Plasma IL-32 protein levels were higher in WLWH compared to women without HIV (p=0.02). Among WLWH, while plasma IL-32 levels did not differ significantly between plaque cases and controls, expression of IL-32 isoforms α, β and ε mRNA was significantly higher in PBMCs from cases (p=0.01, p=0.005, and p=0.018, respectively). Upregulation of IL-32β and IL-32ε among WLWH with carotid artery plaque persisted after adjustment for age, race/ethnicity, smoking, systolic blood pressure, body mass index, and history of hepatitis C virus (p=0.04 and p=0.045); the adjusted association for IL-32α was marginally significant (p=0.07).

IL-32 isoforms should be studied further as potential cardiovascular disease biomarkers. This is of particular interest in WLWH by virtue of altered IL-32 levels in this population.

IL-32 isoforms should be studied further as potential cardiovascular disease biomarkers. This is of particular interest in WLWH by virtue of altered IL-32 levels in this population.

We used data from a routine HIV testing program to develop risk scores to identify patients with undiagnosed HIV infection while reducing the number of total tests performed.

Multivariate logistic regression.

We included demographic factors from HIV testing data collected in 134 Botswana Ministry of Health & Wellness facilities during 2 periods (10/1/2018-8/19/2019 & 12/1/2019-3/30/2020). In period 2, the program collected additional demographic and risk factors. We randomly split each period into prediction/validation datasets and used multivariate logistic regression to identify factors associated with positivity; factors with adjusted odds ratios ≥1.5 were included in the risk score with weights equal to their coefficient. We applied a range of risk score cutoffs to validation datasets to determine tests averted, test positivity, positives missed, and costs averted.

In period 1, 4 factors were significantly associated with HIV positivity (coefficients range 0.44-0.87). In period 2, 13 such factors were identified (coefficients range 0.44-1.37). In Period 1, application of risk score cutoff ≥1.0 would result in 50% fewer tests performed and capture 61% of positives. In Period 2, a cutoff ≥1.0 would result in 13% fewer tests and capture 96% of positives; a cutoff ≥2.0 would result in 40% fewer tests and capture 83% of positives. Costs averted ranged from 12.1-52.3%.

Botswana's testing program could decrease testing volume but may delay diagnosis of some positive patients. Whether this trade-off is worthwhile depends on operational considerations, impact of testing volume on program costs, and implications of delayed diagnoses.

Botswana's testing program could decrease testing volume but may delay diagnosis of some positive patients. Whether this trade-off is worthwhile depends on operational considerations, impact of testing volume on program costs, and implications of delayed diagnoses.

To compare risk factors and clinical outcomes between people living with HIV (PLWH) and HIV-uninfected (HIV-) adults with stroke hospitalized in Zambia.

We retrospectively reviewed charts of all adults admitted to the University Teaching Hospital in Lusaka, Zambia with a clinical diagnosis of stroke between October 2018 and March 2019. Standardized data collection instruments were used to collect demographic, clinical, laboratory and imaging results. Comparison between individuals with and without HIV infection was made using t-tests for continuous parametric variables, Wilcoxon rank-sum tests for continuous non-parametric variables, and chi-square analyses for categorical variables.

272 adults with stroke were admitted of whom 58 (21%) were PLWH. PLB-1001 Compared to HIV- participants, PLWH were younger (48 ± 14) years versus 62 ± 18) years, p < 0.001). PLWH were less likely to have hypertension (65% vs 83%, p = 0.003) and more likely to have no traditional cerebrovascular risk factors (34% vs 15%, p = 0.01). Deep vein thrombosis (DVT) (4% vs 1%, p = 0.04) was more common during hospitalization amongst PLWH, but there was no difference in in-hospital mortality (21% vs 23%, p = 0.65). Among PLWH with stroke, factors associated with in-hospital mortality were Glasgow Coma Scale (GCS) on admission (7 vs 10, p = 0.046), hypertension (92% vs 59%, p = 0.04) and fever (58% vs 13%, p = 0.003).

This Zambian cohort of PLWH and stroke is notable for being significantly younger with fewer traditional stroke risk factors but higher rates of DVT than their HIV-uninfected counterparts. GCS on admission, hypertension and fever were associated with in-hospital mortality.

This Zambian cohort of PLWH and stroke is notable for being significantly younger with fewer traditional stroke risk factors but higher rates of DVT than their HIV-uninfected counterparts. GCS on admission, hypertension and fever were associated with in-hospital mortality.

This review will discuss recent studies showing that patients with chronic wasting diseases suffer from a variety of small intestinal impairments which might negatively impact the colonic microbiota and overall well-being. New insights will be addressed as well as novel approaches to assess intestinal function.

Small intestinal dysfunction can enhance the amount and alter the composition of undigested food reaching the colon. As a result of reduced protein digestion and absorption, a large amount of undigested protein might reach the colon promoting the presence of pathogenic colonic bacteria and a switch from bacterial fiber fermentation to protein fermentation. While microbial metabolites of fiber fermentation, such as short-chain fatty acids (SCFA), are mainly considered beneficial for overall health, metabolites of protein fermentation, i.e. ammonia, branched SCFAs, hydrogen sulfide, polyamines, phenols, and indoles, can exert beneficial or deleterious effects on overall health. Substantial advances have been made in the assessment of small intestinal dysfunction in chronic diseases, but studies investigating the connection to colonic microbial metabolism are needed.