The latest medical research on HIV / AIDS

To evaluate the clinical significance of splenomegaly as a marker of underlying liver disease in people with HIV (PWH).

We included consecutive PWH from a prospective cohort from 2010 to 2020 with available liver stiffness measurement (LSM) and liver imaging to define splenomegaly (> 13 cm) within 1 year. Cut-offs of LSM > 10 kPa and > 21 kPa were used to identify advanced chronic liver disease (ACLD) and portal hypertension, respectively. Logistic regression multivariable analysis was employed to identify independent predictors of ACLD.

In all, 331 PWH were included, 76% of them men, with a median (interquartile range) age of 51.3 (45-58) years, all receiving antiretroviral treatment, and 53% were HIV monoinfected. The PWH with splenomegaly exhibited a higher prevalence of ACLD compared with those with normal spleen size, as per LSM (26% vs. 9%; p = 0.009). Portal hypertension diagnosed by LSM was also more prevalent in PWH with splenomegaly than in those without (15% vs. 2%; p < 0.001). Independent predictors of ACLD were viral hepatitis coinfection [adjusted odds ratio (aOR) = 3.15, 95% confidence interval (CI): 1.65-6.0], lower platelets (aOR = 0.99, 95% CI: 0.99-0.99) and splenomegaly (aOR = 2.41, 95% CI: 1.17-4.99). In patients with available oesophagogastroduodenoscopy, splenomegaly was also associated with higher prevalence of oesophageal varices and other endoscopic findings of portal hypertension (38% vs. 17%; p = 0.027).

Splenomegaly identified on routine imaging may have utility as a marker of ACLD and portal hypertension, prompting further investigations.

To investigate the association of viral load (VL) with (i) tumor necrosis factor-related apoptosis inducing ligand (TRAIL), interferon-gamma induced protein-10, C-reactive protein and a combinatorial score (BV score); and (ii) clinical severity.

In this prospective, multicentre cohort sub-study, children with respiratory tract infection or fever without source were enrolled. VL for influenza virus, rhinovirus, respiratory syncytial virus, and adenovirus were measured from nasopharyngeal swabs. The reference standard diagnosis was established based on expert panel adjudication.

Of 1140 recruited patients, 333 had a virus mono-detection. VL for the aggregated dataset correlated with TRAIL and IP-10 levels, with length of oxygen therapy, and inversely with the BV score. On single viral level, only influenza virus yielded a correlation with TRAIL, IP-10 levels, and the BV score. Children with a viral reference standard diagnosis had significantly higher VL than those with bacterial infection (p = 0.0005). Low TRAIL (incidence rate ratio, IRR 0.6, 95% confidence interval, CI 0.39-0.91) and young age (IRR 0.62, 95%CI 0.49-0.79) were associated with longer hospital stay, while young age (IRR 0.33, 95%CI 0.18-0.61), low TRAIL (IRR 0.25, 95%CI 0.08-0.76), and high VL (IRR 1.16, 95%CI 1.00-1.33) were predictive of longer oxygen therapy.

These findings indicate that VL correlates with biomarkers and may serve as a complementary tool pertaining to disease severity. This article is protected by copyright. All rights reserved.