Early identification of individuals at risk of complications is important to improve dengue case-management and promote appropriate use of limited resources in high burden settings. In this prospective observational cohort, 7428 febrile outpatients were enrolled across 8 countries in Asia and Latin America and followed daily; 2230 individuals with confirmed dengue were included in the analysis, among whom 304 (14%) progressed to moderate/severe dengue and 38 (2%) to severe dengue during follow-up. We demonstrate evolving relationships between common clinical features, WHO clinical warning signs, and simple haematological parameters, with progression. Key predictors of moderate/severe dengue include low lymphocyte percentage, low total white blood cell count, low platelet count, and persistent vomiting and significant abdominal pain/tenderness. Multivariable models incorporating these variables predict the risk of moderate/severe dengue, initially with modest performance (AUC ~ 0.68), but improving subsequently as new daily data is included into the predictions (AUC ~ 0.73-0.85). We also demonstrate that using these models in combination with clinical decision-making pathways could facilitate earlier admission of high-risk patients without markedly increasing admissions of uncomplicated cases. These results should prove instrumental for updating guidelines on dengue triage and management, potentially providing major public health benefits in resource poor settings. Authors used laboratory tests and clinical symptoms to predict dengue progression in a multi-country study. Prediction models improved in accuracy over time, enabling earlier admission of high-risk patients without overwhelming hospital capacity.

Mục tiêu: Đánh giá hiệu quả điều trị kháng vi rút sau 10 năm ở bệnh nhân viêm gan vi rút B mạn tại Bệnh viện Bệnh Nhiệt đới Trung ương. Đối tượng & Phương pháp: Nghiên cứu hồi cứu mô tả trên 1914 bệnh nhân điều trị ngoại trú từ 12/2009 đến 12/2020. Kết quả: Nam giới chiếm 59,8%, tuổi trung bình 43,18±13,7. HBeAg âm tính chiếm 78,1% và 69% đã có xơ gan khi bắt đầu điều trị. Sau 10 năm, tỷ lệ sạch HBsAg đạt 9,5% ở nhóm không xơ gan và 2,9% ở nhóm xơ gan (p<0,001). Không có tử vong ở nhóm không xơ gan nhưng 15,8% tử vong ở nhóm xơ gan. Chỉ 18,5% ung thư gan được phát hiện ở giai đoạn sớm dù được tầm soát định kỳ. Kết luận: Thuốc kháng vi rút NA có hiệu quả cao trong kiểm soát virus và ngăn ngừa biến chứng. Tỷ lệ mất HBsAg đạt 9,5% ở nhóm không xơ gan, cao hơn đáng kể so với nhóm xơ gan (2,9%). Không ghi nhận tử vong ở nhóm không xơ gan, minh chứng cho lợi ích của phát hiện và điều trị sớm.

Vietnam has been experiencing the transition from donor-based to social insurance-based antiretroviral therapy (ART), the COVID-19 pandemic, and expansion of dolutegravir (DTG) use. We assessed virological outcomes, care retention, and effectiveness and tolerability of switching to DTG-containing regimen among people living with HIV (PLHIV) during these changes. PLHIV with suppressed HIV viral load (HIV-VL) who were receiving ART at 11 facilities in North Vietnam were enrolled in a prospective cohort from December 2019 through September 2021 and followed up until March 2023. This cohort of 2,233 PLHIV on ART maintained viral suppression rates (HIV-VL < 50 copies/mL) of > 90% and care retention rates of > 87% throughout the study period. Incidence of viremia (HIV-VL ≥ 200 copies/mL) was 3.2/100 person-years during follow-up. Only 32 (1.4%) PLHIV had any drug resistance mutations; no DTG-associated mutation was observed. Of 1,891 who switched to DTG-containing regimens, 292 (15.4%) discontinued DTG, most commonly owing to DTG stockout (80.8%). Average weight gain was greater in the first measurement after switching than in subsequent measurements. In conclusion, successful maintenance of virologic outcomes of ART and high treatment retention were observed amid various social and clinical changes in Vietnam. These real-world data support the national rollout of DTG.

Establishing population-based cohorts is indispensable for effective epidemic prevention, preparedness and response. Existing passive surveillance systems face limitations in their capacity to promptly provide representative data for estimating disease burden and modelling disease transmission. This perspective paper introduces a framework for establishing a dynamic and responsive nationally representative population-based cohort, with Germany as an example country. We emphasise the need for comprehensive demographic representation, innovative strategies to address participant attrition, efficient data collection and testing using digital tools, as well as novel data integration and analysis methods. Financial considerations and cost estimates for cohort establishment are discussed, highlighting potential cost savings through integration with existing research infrastructures and digital approaches. The framework outlined for creating, operating and integrating the cohort within the broader epidemiological landscape illustrates the potential of a population-based cohort to offer timely, evidence-based insights for robust public health interventions during both epidemics and pandemics, as well as during inter-epidemic periods.

Background Improvements in the early diagnosis of dengue are urgently needed, especially in resource-limited settings where the distinction between dengue and other febrile illnesses is crucial for patient management. Methods In this prospective, observational study (IDAMS), we included patients aged 5 years and older with undifferentiated fever at presentation from 26 outpatient facilities in eight countries (Bangladesh, Brazil, Cambodia, El Salvador, Indonesia, Malaysia, Venezuela, and Viet Nam). We used multivariable logistic regression to investigate the association between clinical symptoms and laboratory tests with dengue versus other febrile illnesses between day 2 and day 5 after onset of fever (ie, illness days). We built a set of candidate regression models including clinical and laboratory variables to reflect the need of a comprehensive versus parsimonious approach. We assessed performance of these models via standard measures of diagnostic values. Findings Between Oct 18, 2011, and Aug 4, 2016, we recruited 7428 patients, of whom 2694 (36%) were diagnosed with laboratory-confirmed dengue and 2495 (34%) with (non-dengue) other febrile illnesses and met inclusion criteria, and were included in the analysis. 2703 (52%) of 5189 included patients were younger than 15 years, 2486 (48%) were aged 15 years or older, 2179 (42%) were female and 3010 (58%) were male. Platelet count, white blood cell count, and the change in these variables from the previous day of illness had a strong association with dengue. Cough and rhinitis had strong associations with other febrile illnesses, whereas bleeding, anorexia, and skin flush were generally associated with dengue. Model performance increased between day 2 and 5 of illness. The comprehensive model (18 clinical and laboratory predictors) had sensitivities of 0middot80 to 0middot87 and specificities of 0middot80 to 0middot91, whereas the parsimonious model (eight clinical and laboratory predictors) had sensitivities of 0middot80 to 0middot88 and specificities of 0middot81 to 0middot89. A model that includes laboratory markers that are easy to measure (eg, platelet count or white blood cell count) outperformed the models based on clinical variables only. Interpretation Our results confirm the important role of platelet and white blood cell counts in diagnosing dengue, and the importance of serial measurements over subsequent days. We successfully quantified the performance of clinical and laboratory markers covering the early period of dengue. Resulting algorithms performed better than published schemes for distinction of dengue from other febrile illnesses, and take into account the dynamic changes over time. Our results provide crucial information needed for the update of guidelines, including the Integrated Management of Childhood Illness handbook.

important role of platelet and white blood cell counts in diagnosing dengue, and the importance of serial measurements over subsequent days. This study successfully quantified the performance of clinical and laboratory markers covering the early period of dengue. These results provide crucial information needed for the update of guidelines, including the Integrated Management of Childhood Illness handbook.

BACKGROUND:Patients with prolonged hospitalisation have a significant risk of carriage of and subsequent infection with extended spectrum β-lactamase (ESBL)-producing and carbapenemase-producing Klebsiella pneumoniae. However, the distinctive roles of the community and hospital environments in the transmission of ESBL-producing or carbapenemase-producing K pneumoniae remain elusive. We aimed to investigate the prevalence and transmission of K pneumoniae within and between the two tertiary hospitals in Hanoi, Viet Nam, using whole-genome sequencing. METHODS:We did a prospective cohort study of 69 patients in intensive care units (ICUs) from two hospitals in Hanoi, Viet Nam. Patients were included if they were aged 18 years or older, admitted for longer than the mean length of stay in their ICU, and cultured K pneumoniae from their clinical samples. Longitudinally collected samples from patients (collected weekly) and the ICU environment (collected monthly) were cultured on selective media, and whole-genome sequences from K pneumoniae colonies analysed. We did phylogenetic analyses and correlated phenotypic antimicrobial susceptibility testing with genotypic features of K pneumoniae isolates. We constructed transmission networks of patient samples, relating ICU admission times and locations with genetic similarity of infecting K pneumoniae. FINDINGS:Between June 1, 2017, and Jan 31, 2018, 69 patients were in the ICUs and eligible for inclusion, and a total of 357 K pneumoniae isolates were cultured and successfully sequenced. 228 (64%) of K pneumoniae isolates carried between two and four different ESBL-encoding and carbapenemase-encoding genes, with 164 (46%) isolates carrying genes encoding both, with high minimum inhibitory concentrations. We found a novel co-occurrence of blaKPC-2 and blaNDM-1 in 46·6% of samples from the globally successful ST15 lineage. Despite being physically and clinically separated, the two hospitals shared closely related strains carrying the same array of antimicrobial resistance genes. INTERPRETATION:These results highlight the high prevalence of ESBL-positive carbapenem-resistant K pneumoniae in ICUs in Viet Nam. Through studying K pneumoniae ST15 in detail, we showed how important resistance genes are contained within these strains that are carried broadly by patients entering the two hospitals directly or through referral. FUNDING:Medical Research Council Newton Fund, Ministry of Science and Technology, Wellcome Trust, Academy of Medical Sciences, Health Foundation, and National Institute for Health and Care Research Cambridge Biomedical Research Centre.

Mục tiêu: 1- Xác định tỷ lệ mang vi khuẩn đa kháng ở bệnh nhân thở máy tại khoa Hồi sức tích cực. 2- Đánh giá sự thay đổi tỷ lệ này trong quá trình bệnh nhân nằm viện. Đối tượng và phương pháp: Nghiên cứu tiến cứu, mô tả cắt ngang. Bệnh nhân ≥ 18 tuổi, có đặt nội khí quản/mở khí quản thở máy, được thu thập bệnh phẩm dịch hút khí phế quản và phân/ngoáy trực tràng tại thời điểm vào viện và mỗi tuần trong quá trình nằm viện để nuôi cấy trên các môi trường chọn lọc nhằm phát hiện các vi khuẩn đa kháng thuốc (VRE, CRE, ESBL enterobacteriae). Kết quả: 189 bệnh nhân đủ tiêu chuẩn được đưa vào nghiên cứu. Tại thời điểm vào viện, 64,5% bệnh nhân mang ít nhất 1 vi khuẩn đa kháng thuốc ở bệnh phẩm phân/ngoáy trực tràng và 52,5% bệnh nhân mang ít nhất 1 vi khuẩn đa kháng thuốc ở bệnh phẩm đường hô hấp. Tỷ lệ này tăng dần trong quá trình bệnh nhân nằm viện, tương ứng là 84,1%; 91,0%; 92,7% ở tuần thứ 1,2,3 nằm viện đối với bệnh phẩm phân/ngoáy trực tràng và 72,5%; 85,7%; 86,7% ở tuần thứ 1,2,3 nằm viện đối với bệnh phẩm đường hô hấp. Các chủng ESBL enterobacteriae chiếm tỷ lệ cao nhất. Kết luận: Hơn một nửa số bệnh nhân đã mang vi khuẩn đa kháng thuốc tại thời điểm nhập viện. Tỷ lệ này gia tăng dần trong quá trình nằm viện. Các chủng ESBL enterobacteriae chiếm tỷ lệ cao nhất ở cả bệnh phẩm phân/ngoáy trực tràng và bệnh phẩm dịch hút khí phế quản.

Xác định đặc điểm kiểu gen của các chủng K. pneumoniae đa kháng thuốc ở BN và môi trường khoa HSTC là rất cần thiết để áp dụng các biện pháp điều trị phù hợp, đồng thời xác định được nguồn lây truyền của vi khuẩn để kiểm soát nhiễm khuẩn hiệu quả. Mục tiêu: xác định đặc điểm kiểu gen của các chủng K. pneumoniae đa kháng thuốc bằng kỹ thuật giải trình tự gen thế hệ mới. Đối tượng và phương pháp: mẫu bệnh phẩm đờm, phân, nước tiểu và mủ vết thương (nếu có) thu thập từ BN và mẫu bệnh phẩm thu thập từ môi trường khu vực quanh giường bệnh. Nghiên cứu tiến cứu, mô tả cắt ngang. sử dụng kỹ thuật giải trình tự gen thế hệ mới (NGS) để giải trình tự toàn bộ bộ gen của các chủng K. pneumoniae. Kết quả: từ 832 chủng K. pneumoniae thu thập đã xác định được 68 STs của K. pneumoniae với sự nổi trội của ST15 (34%) và ST16 (20%). Các gen kháng thuốc gặp phổ biến là blaNDM (54,45%), blaOXA (46,51%), blaKPC (45,07%), blaCTX (51,80%), blaSHV (98,44%), blaTEM (52,16%). Ghi nhận sự xuất hiện thường xuyên của các chủng K. pneumonia đa kháng thuốc trên BN và/hoặc môi trường khoa HSTC trong toàn bộ thời gian nghiên cứu. Kết luận: có sự phân bố một số STs đặc trưng riêng của K. pneumoniae tại địa điểm nghiên cứu. Số lượng các gen kháng thuốc gặp phổ biến khá nhiều.

The Global AIDS Strategy 2021-2026 identifies adolescent girls and young women (AGYW) as a priority population for HIV prevention, and recommends differentiating intervention portfolios geographically based on local HIV incidence and individual risk behaviours. We estimated prevalence of HIV risk behaviours and associated HIV incidence at health district level among AGYW living in 13 countries in sub-Saharan Africa. We analysed 46 geospatially-referenced national household surveys conducted between 1999-2018 across 13 high HIV burden countries in sub-Saharan Africa. Female survey respondents aged 15-29 years were classified into four risk groups (not sexually active, cohabiting, non-regular or multiple partner[s] and female sex workers [FSW]) based on reported sexual behaviour. We used a Bayesian spatio-temporal multinomial regression model to estimate the proportion of AGYW in each risk group stratified by district, year, and five-year age group. Using subnational estimates of HIV prevalence and incidence produced by countries with support from UNAIDS, we estimated new HIV infections in each risk group by district and age group. We then assessed the efficiency of prioritising interventions according to risk group. Data consisted of 274,970 female survey respondents aged 15-29. Among women aged 20-29, cohabiting (63.1%) was more common in eastern Africa than non-regular or multiple partner(s) (21.3%), while in southern countries non-regular or multiple partner(s) (58.9%) were more common than cohabiting (23.4%). Risk group proportions varied substantially across age groups (65.9% of total variation explained), countries (20.9%), and between districts within each country (11.3%), but changed little over time (0.9%). Prioritisation based on behavioural risk, in combination with location- and age-based prioritisation, reduced the proportion of population required to be reached in order to find half of all expected new infections from 19.4% to 10.6%. FSW were 1.3% of the population but 10.6% of all expected new infections. Our risk group estimates provide data for HIV programmes to set targets and implement differentiated prevention strategies outlined in the Global AIDS Strategy. Successfully implementing this approach would result in more efficiently reaching substantially more of those at risk for infections.

Objectives: In early 2021, when the COVID-19 vaccine was scarce in Vietnam, healthcare workers (HCWs) were prioritized for vaccination due to high risk of occupational exposure. However, there is some COVID-19 vaccine hesitancy within HCW communities. Assessing COVID-19 severity among vaccinated and nonvaccinated HCWs would contribute essential information to assure people of vaccine effectiveness and reduce vaccine hesitancy. Methods: We conducted a descriptive cross-sectional study at the National Hospital for Tropical Diseases in Hanoi, Vietnam, from May to June 2021. Clinical and epidemiological data from HCWs with positive polymerase chain reaction (PCR) results were collected. The severity of symptoms were classified according to Vietnam Ministry of Health guideline (Decision no. 3416 issued July 14, 2021) into 5 categories: asymptomatic, mild, moderate, severe, and critical conditions Results: Overall, 25 HCWs qualified for this study (14 women and 11 men), with a median age of 31 years. Among them, 3 HCWs were infected due to community exposure, and the rest were infected due to occupational exposure. Also, 3 HCWs received the Astra Zeneca vaccine before being infected with SARS-CoV-2 (one fully vaccinated with 2 doses and the other 2 had had the first dose). Categorized by the severity of infection, 28% were asymptomatic, 44% had mild symptoms, 20% had moderate symptoms, and 8% experienced severe symptoms. All 3 vaccinated HCWs showed only mild symptoms. Cough and sore throat were the main symptoms recorded (60%), followed by fever (56%). Blood test results did not show significant differences between the severe and mild COVID-19 groups. Conclusions: COVID-19 vaccination reduced the severity of COVID-19 in this small sample of HCWs. Full COVID-19 vaccination is strongly recommended for HCWs to reduce the spread of COVID-19 and to limit the number of cases with severe disease.

Murine typhus is a flea - borne disease caused by Rickettsia typhi. Although this disease was discovered re-cently, it has become widespread all over the world. Murine typhus is a common disease of rats and small mammals with rat flea (Xenopsylla cheopis) as the vector of transmission. People infected with R.typhi via the fae-ces of flea infiltrate through: stings, scratched skin, in-halation, mucosa contamination with various clinical manifestations. Objectives: To describe clinical and subclinical characteristics for patients with R.typhi. Subjects and methods: Descriptive cross - sectional study on patients with fever and positive realtime PCR result for R.typhi at different research areas from 8 Vietnamese eco-logical regions throughout the period from June 2018 to June2019. Results: clinical manifestations of R.typhi infected patients included: fever (100%), headache (94.64%), myalgia (62.5%), skin congestion (78.57%), conjunctival congestion (50%), rash (41.07%). The rate of patients with peripheral leukocytosis was 25%, neu-tropenia was 50%, there were 69.64% of patients with thrombocytopenia. 100% of patients had increased CRP, the rate of patients with increased AST was 66.67%, the increase of ALT was 95.12%. Conclusion: Murine typhus has diverse clinical and subclinical manifestations and is quite diverse and non - specific.

BACKGROUND:Cryptococcal meningitis (CM) is a major cause of morbidity and mortality in persons with human immunodeficiency virus (HIV; PWH). Little is known about CM outcomes and availability of diagnostic and treatment modalities globally.METHODS:In this retrospective cohort study, we investigated CM incidence and all-cause mortality in PWH in the International Epidemiology Databases to Evaluate AIDS cohort from 1996 to 2017. We estimated incidence using quasi-Poisson models adjusted for sex, age, calendar year, CD4 cell count (CD4), and antiretroviral therapy (ART) status. Mortality after CM diagnosis was examined using multivariable Cox models. A site survey from 2017 assessed availability of CM diagnostic and treatment modalities.RESULTS:Among 518 852 PWH, there were 3857 cases of CM with an estimated incidence of 1.54 per 1000 person-years. Mortality over a median of 2.6 years of post-CM diagnosis follow-up was 31.6%, with 29% lost to follow-up. In total, 2478 (64%) were diagnosed with CM after ART start with a median of 253 days from ART start to CM diagnosis. Older age (hazard [HR], 1.31 for 50 vs 35 years), lower CD4 (HR, 1.15 for 200 vs 350 cells/mm3), and earlier year of CM diagnosis (HR, 0.51 for 2015 vs 2000) were associated with higher mortality. Of 89 sites, 34% reported access to amphotericin B; 12% had access to flucytosine.CONCLUSIONS:Mortality after CM diagnosis was high. A substantial portion of CM cases occurred after ART start, though incidence and mortality may be higher than reported due to ascertainment bias. Many sites lacked access to recommended CM treatment.

Background: DNA sequencing could become an alternative to in vitro antibiotic susceptibility testing (AST) methods for the detection of bacterial antibiotic resistance. This is exemplified by the success in predicting antibiotic resistance (ABR) from the genomes of bacteria such as Mycobacterium tuberculosis, Staphylococcus aureus or Streptococcus pneumoniae. Here, we explored the feasibility of determining antibiotic susceptibility with high accuracy from Enterococcus faecium genomes.Methods: We conducted a literature search to compile a catalogue of genes and mutations predictive of antibiotic resistance in E. faecium. We evaluated the diagnostic performance of this database to determine susceptibility to 15 different antibiotics using a dataset of 4,730 E. faecium isolates with available whole-genome sequences and in vitro culture-based AST phenotypes. We additionally used CARD, ResFinder, AMRFinder and LRE-Finder to assess their prediction performance against phenotypic resistance.Results: Our results show that very accurate genotypic predictions can be obtained for ampicillin, ciprofloxacin, vancomycin and linezolid resistance, with sensitivity and specificity well above 95%. High sensitivity (above 90%) was also obtained for clindamycin, erythromycin, tetracyclines, teicoplanin, and aminoglycosides, although at lower specificity (60 to 90%). Sensitivity was expectedly lower for daptomycin (26.6%) and tigecycline (38.3%), for which the mechanisms of resistance are less well understood. CARD, AMR-Finder and ResFinder produced less accurate predictions than our curated database for most antibiotics, and particularly in terms of specificity.Conclusion: This work represents the largest published effort to date at evaluating the accuracy of antibiotic susceptibility predictions from E. faecium genomes. Our findings demonstrated an improved diagnostic accuracy compared to available ABR databases and bioinformatic tools, and provide new information for future improvements on ABR genotype–phenotype concordance in E. faecium.Funding: This publication presents independent research supported by Wellcome grants 201344/Z/16/Z and 204928/Z/16/Z awarded to Francesc Coll. This publication was also supported by the Health Innovation Challenge Fund (WT098600, HICF-T5-342), a parallel funding partnership between the Department of Health and Wellcome Trust. The Addenbrookes ICU study was supported by a Clinician Scientist Fellowship to MET, funded by the Academy of Medical Sciences and the Health Foundation, and by the NIHR Cambridge Biomedical Research Centre. The Vietnam ICU study was funded by the Medical Research Council Newton Fund (grant reference MR/N029399/1) and the Vietnamese Ministry of Science and Technology (grant reference HNQT/SPDP/04.16). C.L. was supported by a Wellcome Trust Sir Henry Postdoctoral Fellowship (110243/Z/15/Z). This study has also been funded by a Research Grant 2020 of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) awarded to K.E.R. L.W.R. was funded by an EBPOD fellowship from EMBL. The views expressed in this publication are those of the author(s) and not necessarily those of the funders. We acknowledge the British Society for Antimicrobial Chemotherapy (BSAC) as a source of E. faecium isolates in this study.Declaration of Interests: The authors declare no competing interests. SJP and JP are consultants to Next Gen Diagnostics.

Complete diagnostic autopsy (CDA) is the gold standard in determining the cause of death. However, according to the statistics of the World Health Organization, the practice of CDA has been on a dramatic decline in high - income countries or has not been recorded consistently in low - and middle - income countries, including Vietnam, for the last few decades. This is due to capacity and resource issues as well as cultural and religious factors regarding management of corpses. As a result, the development of quick, less invasive procedures becomes necessary in order to improve the statistics of cause of death worldwide. One such procedure that has the potential to serve as an alternative to complete diagnostic autopsy is minimally invasive autopsy (MIA). This procedure involves using hollow needles to take samples from different tissues and fluids from key organs before combining histology and microbiology to determine the cause of death. This paper aims to explore this novel procedure as well as its potential in becoming the dominant post - mortem examination, especially in the context of infectious causes of death.

Background: HIV-associated renal disease was considered as an etiology of fatal condition in patients with HIV. Few equations (Chronic Kidney Disease Epidemiology Collaboration, Modification of Diet in Renal Disease and Cockcroft-Gault) have been used in clinical for calculating creatinine clearance, however the prediction of these formulae in HIV patients have been different. Our goal was to evaluate the effect of baseline eGFR by three equations on 6- month and 12-month mortality in advanced HIV patients. Materials and method: We conduct a retrospective, observation cohort study of patients with HIV infection who firstly presented for care at selected HIV OPCs in Vietnam. Results: Of total of 1108 patients was eligible for analysis. HIV- positive patients with CKD stage 3 and 4 defined by CG and MDRD formula increased risk of 6- month and 12- month mortality. CKD-EPI were not correlated with 6-month and 12-month mortality in any stage of CKD. AUC (area unde curves) for 6-month mortality and 12-month with respect to eGFR calculated by CG formula was statistically higher than AUC by CKD-EPI and MDRD (p < 0.05, Delong test). Conclusion: Low eGFR calculated by CG were associated with higher mortality in patients with advanced HIV. Key words: HIV, eGFR, CKD-EPI, MRDR, CG.

BACKGROUND:Non-Asian body mass index (BMI) classifications are commonly used as a risk factor for high fasting blood glucose (FBG). We investigated the incidence and factors associated with high FBG among people living with HIV in the Asia-Pacific region, using a World Health Organization BMI classification specific to Asian populations. METHODS:This study included people living with HIV enrolled in a longitudinal cohort study from 2003 to 2019, receiving antiretroviral therapy (ART), and without prior tuberculosis. BMI at ART initiation was categorized using Asian BMI classifications: underweight (<18.5 kg/m2 ), normal (18.5-22.9 kg/m2 ), overweight (23-24.9 kg/m2 ), and obese (≥25 kg/m2 ). High FBG was defined as a single post-ART FBG measurement ≥126 mg/dL. Factors associated with high FBG were analyzed using Cox regression models stratified by site. RESULTS:A total of 3939 people living with HIV (63% male) were included. In total, 50% had a BMI in the normal weight range, 23% were underweight, 13% were overweight, and 14% were obese. Median age at ART initiation was 34 years (interquartile range 29-41). Overall, 8% had a high FBG, with an incidence rate of 1.14 per 100 person-years. Factors associated with an increased hazard of high FBG included being obese (≥25 kg/m2 ) compared with normal weight (hazard ratio [HR] = 1.79; 95% confidence interval [CI] 1.31-2.44; p < 0.001) and older age compared with those aged ≤30 years (31-40 years: HR = 1.47; 95% CI 1.08-2.01; 41-50 years: HR = 2.03; 95% CI 1.42-2.90; ≥51 years: HR = 3.19; 95% CI 2.17-4.69; p < 0.001). CONCLUSION:People living with HIV with BMI >25 kg/m2 were at increased risk of high FBG. This indicates that regular assessments should be performed in those with high BMI, irrespective of the classification used.

Background Debuting sexual intercourse marks exposure to pregnancy or fatherhood and sexually transmitted infections (STIs), including HIV. In sub-Saharan Africa (SSA), sexual debut varies according to cultural, religious, and economic factors, and encouraging delay has been a longstanding component of behavioural HIV prevention strategies. Age at first sex (AFS) is routinely collected in national household surveys, but data are affected by reporting biases, limiting utility to monitor trends and guide sexual health interventions. Methods We collated individual-level data from nationally-representative household surveys to analyse timing and national trends in AFS in 42 SSA countries. We used a log-skew-logistic distribution to characterize the time to AFS in a Bayesian spatio-temporal model, providing estimates of the sexual debut rate by sex, age, time, and country. We statistically adjusted for reporting biases by comparing AFS reported by the same birth cohorts in multiple survey rounds, allowing different reporting biases by sex and country. Results Median AFS in 2015 ranged from 15.8 among Angolan women to 25.3 among men in Niger. AFS was younger for women than men in 37/40 countries. The gap was largest for Sahel region countries and minimal in southern African countries. The distribution of female AFS was asymmetric with half debuting sex in an age range of 3.9 years [IQR 3.4–5.0 across countries]. Median AFS increased slightly between 1985 and 2020, ranging 0.84 years [IQR 0.11–1.55] and 0.79 [IQR -0.23–1.98] for females and males, respectively. The gender gap changed little over time in most countries. Female teens often reported higher AFS compared to when asked in their late twenties while male teens reported lower AFS; both sexes recalled a higher AFS in older ages compared to their thirties. Conclusions AFS increased slightly in most SSA countries, but changes were modest relative to large and persistent variation between countries and sexes, indicating relatively entrenched socio-cultural practices around sexual debut. Sexual health, family planning, and HIV/STI prevention services should adapt to local practices rather than focusing interventions to change AFS. These estimates for rates of sexual debut provide data to guide programmatic prioritization and implementation of sexual health services.

There is little evidence regarding the association between hepatitis B virus (HBV) chronicity and HLA-DP among the HIV-infected Vietnamese population. To study this, we conducted a cross-sectional analysis and a prospective study involving an HIV-infected Vietnamese cohort. The association between HBV chronicity and HLA-DP single nucleotide polymorphisms (SNPs) of rs3077 and rs9277535 among Vietnamese patients with previous HBV exposure was first evaluated. In addition, treatment-naive patients with chronic HBV infection were followed between 2012 and 2017 for HBV clearance after the initiation of antiretroviral therapy (ART). A total of 820 subjects with previous HBV exposure were included in the cross-sectional study. Among them, 147 (17.9 %) had chronic HBV infection, and 673 (82.1 %) achieved HBV clearance. The proportions of minor allele homozygotes of rs3077 and rs9277535 were 10.9 % and 15.2 % (p = 0.481) and 4.1 % and 11.7 % (p = 0.003), respectively. Multivariate analysis showed that rs9277535 minor homozygote was a significant protective factor against chronic HBV infection (odds ratio [OR], 0.271; 95 % confidence interval [CI]; 0.114-0.642, p = 0.001). Further, none of the 43 patients in the prospective study, who received ART possessed the rs9277535 minor homozygote. The average follow-up period was 4.8 years, and 10 subjects (23.3 %, 4.9 %/person-years) achieved HBV clearance. Univariate analysis revealed that the SNPs were not significantly associated with HBV clearance. In conclusion, our study confirmed that the rs9277535 minor allele homozygote was significantly associated with HBV clearance among HIV-infected Vietnamese patients.

In Vietnam, the public health burden of rickettsial infections continues to be underestimated due to knowledge gaps in the epidemiology of these diseases. We conducted a systematic study among 27 hospitals from 26 provinces in eight ecological regions throughout Vietnam to investigate the prevalence, distribution, and clinical characteristics of rickettsial diseases. We recruited 1834 patients in the study from April 2018 to October 2019. The findings showed that rickettsial diseases were common among undifferentiated febrile patients, with 564 (30.8%) patients positive by qPCR for scrub typhus, murine typhus or spotted fever. Scrub typhus (484, 85.8%) was the most common rickettsial disease, followed by murine typhus (67, 11.9%) and spotted fever (10, 1.8%). Rickettsial diseases were widely distributed in all regions of Vietnam and presented with nonspecific clinical manifestations.