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Chkhartishvili N.,and Clinical Immunology Research Center
Georgian medical news

Due to the shared routes of transmission, co-infection with Human Immunodeficiency Virus (HIV) and other sexually transmitted infections (STIs) is common. There is strong evidence of bidirectional interactions between HIV and ulcerative STIs. Recent studies have also shown importance of non-ulcerative inflammatory STIs in the acquisition of HIV. The incidence of HIV and Chlamydia in Georgia has risen every year. We explored the extent of the problem of co-infection with C. trachomatis in HIV patients in the country. Study included 234 consecutive patients diagnosed with HIV from September 2008 through May 2009. Of them, approximately two-thirds were male 162 (69.23%), up to 44% (102) of patients had more than one lifetime sexual partner and one fifth of patients reported prior history of STIs. The seroprevalence of C. trachomatis in our study was 23.93% (95% CI: 18.61%-29.92%). In multivariate analysis the strongest predictors of C. trachomatis infection were history of STI (PR 1.94, 95% CI: 1.22-3.07) and female gender (PR 1.79, 95% CI: 1.11-2.87), while younger age and not being in marriage showed borderline significance. Findings of our study have important public health and clinical implications. Data suggest that STIs may play important role in increasing heterosexual transmission of HIV in Georgia. Efforts should be made to expand HIV screening programs. Further research is needed to better understand the role of inflammatory STIs in spreading HIV. Source

Dvali N.,and Clinical Immunology Research Center
Georgian medical news

A hypersensitivity reaction to abacavir develops in approximately 2-8% of HIV patients receiving this drug and is strongly associated with presence of the human leukocyte antigen (HLA)-B*5701. Screening for HLA-B*5701 reduces the risk of developing an abacavir hypersensitivity reaction. The carriage rate of HLA-B*5701 has not been studied in Georgia before 2009. Objective of the study was to determine HLA-B*5701 prevalence in HIV-infected patients in Georgia. One hundred and sixty HIV positive patients attending Georgian Infectious Diseases, AIDS and Clinical Immunology Research Center in 2009 were recruited for the study. None of the patients had previously been treated with abacavir. Blood samples were collected and screened for HLA-B*5701 prior to abacavir prescription. Of 160 patients recruited 9 tested HLA B*5701 positive - 5.6% (95% CI: 2.6-10.4%). Of these nine patients 7 were males (male prevalence: 6.5%, 95% CI: 2.6-12.9 %) and 2 females (female prevalence: 4.8%, 95% CI: 0.6-16.2%). The first prospective study of HLA-B*5701 prevalence in Georgia show similar results to the results of other studies. Abacavir still remains one of the key drugs of antiretroviral regimens in Georgia and other countries. Therefore, prospective HLA-B*5701 screening should be implemented in all settings where abacavir is widely used to guide selection of ART regimens and to reduce the risk of potentially life threatening hypersensitivity reaction. Source

Lomtadze N.,National Center for Tuberculosis and Lung Diseases | Kupreishvili L.,National Center for Tuberculosis and Lung Diseases | Salakaia A.,National Center for Tuberculosis and Lung Diseases | Vashakidze S.,National Center for Tuberculosis and Lung Diseases | And 5 more authors.

Background: The country of Georgia has a high prevalence of tuberculosis (TB) and hepatitis C virus (HCV) infection. Purpose: To determine whether HCV co-infection increases the risk of incident drug-induced hepatitis among patients on first-line anti-TB drug therapy. Methods: Prospective cohort study; HCV serology was obtained on all study subjects at the time of TB diagnosis; hepatic enzyme tests (serum alanine aminotransferase [ALT] activity) were obtained at baseline and monthly during treatment. Results: Among 326 study patients with culture-confirmed TB, 68 (21%) were HCV co-infected, 14 (4.3%) had chronic hepatitis B virus (HBV) infection (hepatitis B virus surface antigen positive [HBsAg+]), and 6 (1.8%) were HIV co-infected. Overall, 19% of TB patients developed mild to moderate incident hepatotoxicity. In multi-variable analysis, HCV co-infection (adjusted Hazards Ratio [aHR]=3.2, 95% CI=1.6-6.5) was found to be an independent risk factor for incident anti-TB drug-induced hepatotoxicity. Survival analysis showed that HCV co-infected patients developed hepatitis more quickly compared to HCV seronegative patients with TB. Conclusion: A high prevalence of HCV co-infection was found among patients with TB in Georgia. Drug-induced hepatotoxicity was significantly associated with HCV co-infection but severe drug-induced hepatotoxicity (WHO grade III or IV) was rare. © 2013 Lomtadze et al. Source

Vora N.M.,Centers for Disease Control and Prevention | Li Y.,Centers for Disease Control and Prevention | Geleishvili M.,Centers for Disease Control and Prevention | Emerson G.L.,Centers for Disease Control and Prevention | And 15 more authors.
New England Journal of Medicine

During 2013, cutaneous lesions developed in two men in the country of Georgia after they were exposed to ill cows. The men had never received vaccination against smallpox. Tests of lesion material with the use of a quantitative real-time polymerase-chain-reaction assay for non-variola virus orthopoxviruses were positive, and DNA sequence analysis implicated a novel orthopoxvirus species. During the ensuing epidemiologic investigation, no additional human cases were identified. However, serologic evidence of exposure to an orthopoxvirus was detected in cows in the patients' herd and in captured rodents and shrews. A third case of human infection that occurred in 2010 was diagnosed retrospectively during testing of archived specimens that were originally submitted for tests to detect anthrax. Orthopoxvirus infection should be considered in persons in whom cutaneous lesions develop after contact with animals. Copyright © 2015 Massachusetts Medical Society. Source

Chkhartishvili N.,and Clinical Immunology Research Center | Rukhadze N.,and Clinical Immunology Research Center | Svanidze M.,and Clinical Immunology Research Center | Sharvadze L.,and Clinical Immunology Research Center | And 6 more authors.
Journal of the International AIDS Society

Introduction: There is little information on adherence to antiretroviral therapy (ART) in the Eastern European region. This prospective study evaluated multiple measures of adherence and their association with viral suppression among HIV patients in Georgia. Methods: A prospective cohort study enrolled 100 consecutive antiretroviral-naïve adult (age ≥18 years) patients, who were followed for three months. Adherence was assessed by medication refill and three self-report measures (an AIDS Clinical Trial Group [ACTG] tool for four-day adherence, a visual analogue scale [VAS] and a rating task for 30-day adherence). The VAS represented a line anchored by 0 and 100% corresponding to the percentage of prescribed doses taken. The rating task asked patients to rate their ability to take all medications as prescribed, with responses categorized into six levels of adherence: very poor (0%), poor (20%), fair (40%), good (60%), very good (80%) and excellent (100%). Patients with adherence of ≥95% by medication refill, ACTG and VAS, and ≥80% by rating task, were defined as adherent. Results: Of 100 patients enrolled, eight had missing data and were excluded from analysis. Among the remaining 92 patients, the median age was 39 years, and 70% were men. Major modes of HIV acquisition were injection drug use (IDU; 47.3%) and heterosexual contact (44.1%). The proportions of adherent patients were as follows: 68% by medication refill, 90% by ACTG questionnaire, 38% by VAS and 42% by rating task. On average, four months after commencing ART, 52 (56.5%) patients had a viral load <400 copies/ml and 26 (28.3%) patients had a viral load <50 copies/ml. Of 43 persons with a history of IDU, 22 (51.2%) reached a viral load of <400 copies/ml. In multivariate analysis, only refill adherence was a statistically significant predictor of viral suppression of <400 copies/ml: the risk ratio was 1.7 (95% CI: 1.1-2.8). Refill adherence, VAS and rating task were associated with viral suppression of <50 copies/ml. Non-IDUs were twice as likely to achieve viral load <50 copies/ml compared to IDUs. Refill adherence had the largest area under the receiver-operating characteristic curve for predicting viral suppression. Conclusions: Medication refill adherence was the strongest predictor of viral suppression. IDUs can achieve optimal virologic outcomes, but may require additional adherence support. © 2014 Chkhartishvili N et al; licensee International AIDS Society. Source

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