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BACKGROUND:Hepatocellular carcinoma (HCC) risk is elevated among people with human immunodeficiency virus (HIV) (PWH), but survival disparities are poorly understood. METHODS:We used data from the HIV/AIDS Cancer Match Study, a U.S. population-based linkage of 12 HIV and cancer registries during 2001-2019. Multivariable-adjusted Cox regression was used to estimate adjusted hazard ratios (aHRs) for HIV and HCC-specific and all-cause mortality among people with HCC, and to estimate aHRs for factors associated with HCC-specific and all-cause mortality among PWH. RESULTS:A total of 71 516 cases of HCC including 1610 PWH occurred during 2001-2019. Compared to people with HCC without HIV, a higher proportion of PWH were men, younger at time of cancer diagnosis, and were Black or Hispanic. Overall, 1279 deaths occurred among PWH (62.5% of deaths from HCC). HIV was associated with 34% higher all-cause mortality (aHR 1.34; 95% confidence interval, 1.27-1.41), and slightly increased HCC-specific mortality (aHR 1.08; 95% confidence interval, 1.01-1.16). Male sex, older age at HCC diagnosis, and nonreceipt of cancer treatment modalities were associated with increased all-cause and HCC-specific mortality among PWH. Increased HCC-specific mortality was also observed among men who have sex with men, compared to people who inject drugs. All-cause and HCC-specific mortality declined across calendar periods from 2001-2003 to 2016-2019 (Ptrends & .0002 and .06, respectively). CONCLUSIONS:HIV is associated with 34% higher all-cause and 8% higher HCC-specific mortality among PWH with HCC compared to those without HIV. As PWH are now living longer, and are at higher risk of HCC, research should prioritize opportunities for HCC prevention, screening, diagnosis, and treatment.
Abstract Tuberculosis screening is not mandatory for prospective tissue donors. In 2021 and 2023, two different bone allograft products caused nationwide tuberculosis outbreaks. We assessed the morbidity and mortality of the second outbreak and reviewed donor and tissue screening to identify deficiencies. Thirty-six people residing in nine states received the product during spinal and dental procedures. Twenty-seven recipients had tuberculosis infection, 11 had microbiologic or imaging evidence of tuberculosis disease, and two died from tuberculosis within 12 months of outbreak detection. Another recipient died from tuberculosis nearly 3 years after product implantation. The bone donor died of pneumonia and septic shock. Polymerase chain reaction testing of the product before and after distribution did not detect Mycobacterium tuberculosis . Mycobacterial culture was not performed until after outbreak detection, when M. tuberculosis was isolated from 2 of 6 unused product units. This outbreak demonstrates persistent gaps in tissue transplant safety. Appropriate selection of donors and mycobacterial culture of donated tissues could reduce but not eliminate the risk of M. tuberculosis transmission. Therefore, it is important that clinicians monitor tissue recipients and promptly report adverse events to tissue establishments and health authorities.
INTRODUCTION:Small intestinal atresia (SIA) consists of a congenital obstruction of the lumen of the duodenum, jejunum, or ileum with varying severity. The aim of the investigation was to analyze the prevalence and mortality of SIA, using data from the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). METHODS:Data on SIA cases were collected from 25 ICBDSR members' surveillance programs in 17 countries over 1974-2015. All pregnancy outcomes were included, but terminations of pregnancy were not available for 11 programs. Statistical analysis is descriptive, and the prevalence is established by the total of SIA cases divided by the total of births. The survival time was calculated, and mortality was analyzed individually using the Kaplan-Meier method for comparison. RESULTS:The total prevalence of SIA was 2.1 per 10,000 births. Iran had the highest prevalence with 11.5 per 10,000 total births (95% CI: 9-14.1); on the other hand, the lowest prevalence of SIA was in Mexico-Nuevo Leon with 0.5 per 10,000 births (95% CI: 0.3-0.8), and Cali-Colombia had zero cases. In South America, a higher prevalence of SIA was estimated compared to what was reported in 2000. Most deaths occurred between Day 2 and 6, except in Bogotá-Colombia, Spain, UK-Wales, and Mexico, where the deaths occurred on Day 1. The mortality in the first year was 4.3%, but the specific causes of death were not determined in this study. CONCLUSION:The prevalence of SIA was about 2.1 per 10,000 births during a 41-year period in 25 centers, with variations in prevalence according to geographical locations. Future research is suggested to analyze changes in trends and the impact of early diagnosis and treatment in mortality.
BACKGROUND:Children's Hospital of Philadelphia (CHOP) identified a MeV case in late 2023 and also early 2025, both of which were associated with international travel. Of the 24 MeV genotypes, the B3 and D8 lineages have been the most prevalent globally since 2021. Initial genotyping indicated that the two CHOP isolates belong to the B3 lineage. OBJECTIVES:To inform MeV molecular surveillance, we conducted a genomic epidemiology analysis to situate the CHOP strains within the global genetic landscape of past and present MeV B3 cases. STUDY DESIGN:We performed whole-genome amplification, genome assembly, and phylogenomics of our two MeV cases. These strains were then analyzed alongside all 168 National Center for Biotechnology Information near-full length MeV B3 genomes using population and evolutionary genetic approaches. This dataset includes strains isolated from 13 countries between 2005 and 2025. RESULTS:The two CHOP strains form a monophyletic group with 39 other isolates from four countries; 36 clade members form a discrete network connected by a 15 single nucleotide polymorphism (SNP) cutoff. The CHOP clade shares a Q45H phosphoprotein mutation at a codon undergoing diversifying selection, as with a H593R hemagglutinin mutation carried by the 2025 CHOP strain. The CHOP clade likely diverged in 2019 and has a median root-to-tip distance of 0.020 compared to 0.017 for the other B3 strains, consistent with this clade encompassing the most recently divergent nodes. CONCLUSIONS:Our work places the CHOP MeV cases within a diversifying and emergent global clade of the dominating B3 lineage that is a future risk due to ongoing B3 MeV transmission.
