Background: Over the last few years, probiotics have been one of the most studied interventions in neonatal medicine. Objectives: </

/pdf/the-golden-age-of-probiotics-a-systematic-review-and-meta-pka4l553p3.pdf

The “Golden Age” of Probiotics: A Systematic Review and Meta-Analysis of Randomized and Observational Studies in Preterm Infants

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(06)68880-6.pdf

Mild cognitive impairment

Invasive candidiasis (IC) is a leading cause of mycosis-associated mortality in the United States. We examined data from the National Center for Health Statistics and reviewed recent literature in order to update the epidemiology of IC. IC-associated mortality has remained stable, at approximately 0.4 deaths per 100,000 population, since 1997, while mortality associated with invasive aspergillosis has continued to decline. Candida albicans remains the predominant cause of IC, accounting for over half of all cases, but Candida glabrata has emerged as the second most common cause of IC in the United States, and several less common Candida species may be emerging, some of which can exhibit resistance to triazoles and/or amphotericin B. Crude and attributable rates of mortality due to IC remain unacceptably high and unchanged for the past 2 decades. Nonpharmacologic preventive strategies should be emphasized, including hand hygiene; appropriate use, placement, and care of central venous catheters; and prudent use of antimicrobial therapy. Given that delays in appropriate antifungal therapy are associated with increased mortality, improved use of early empirical, preemptive, and prophylactic therapies should also help reduce IC-associated mortality. Several studies have now identified important variables that can be used to predict risk of IC and to help guide preventive strategies such as antifungal prophylaxis and early empirical therapy. However, improved non-culture-based diagnostics are needed to expand the potential for preemptive (or early directed) therapy. Further research to improve diagnostic, preventive, and therapeutic strategies is necessary to reduce the considerable morbidity and mortality associated with IC.

Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem

Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.

https://www.easy-immune-health.com/support-files/clin_practice_guidelines_candidiasis.pdf

Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America.

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1053/jhep.2001.29401

Chronic hepatitis B

A closer look at hepatitis C clearance in HIV controllers.

Background
Human papillomavirus (HPV) types 16 and 18 cause invasive cervical cancer and most invasive anal cancers (IACs). Overall, IAC rates are highest among men who have sex with men (MSM), especially MSM with HIV infection. Testosterone is prescribed for men showing hypogonadism and HIV-related wasting. While there are direct and indirect physiological effects of testosterone in males, its role in anal HPV16/18 infections in men is unknown.

/pdf/association-between-free-testosterone-levels-and-anal-human-4eziac3awk.pdf

Association between Free Testosterone Levels and Anal Human Papillomavirus Types 16/18 Infections in a Cohort of Men Who Have Sex with Men

Hepatitis C Viremia and Diffusing Capacity for Carbon Monoxide in Women With and Without Human Immunodeficiency Virus

GlycA is associated with neuropsychological impairment in men with HIV.

To the Editor—We read with interest the comments by Bradshaw and Danta on our article [1] and would like to address several points. Comparing our study to the UK study is problematic because the UK study described a group of men who have sex with men (MSM) during the early and current highly active antiretroviral therapy (HAART) eras (1998–2008) [2]. In contrast, 83% of participants in our study were enrolled during the pre-HAART era. Because sexual practices in the MSM community changed rapidly as effective anti–human immunodeficiency virus (HIV) therapies evolved, a comparison between our study and the UK study may be confounded by changes in sexual behaviors in the gay community between 1984 and 2011.

The authors also state that “rates of URAI [unprotected receptive anal sex] declined in later recruits” and speculate that this decline could be attributed to underreporting. In fact, we did not discuss trends in URAI rates. Rather, we reported in our Table 1 [1] the proportions of men who reported a history of URAI with multiple partners prior to enrollment into the Multicenter AIDS Cohort Study (MACS)—essentially a baseline assessment. However, to address the point raised, we examined the reported rates of URAI and found that those rates for later recruits were comparable to those reported by earlier recruits during follow-up in 2001. Thus, we did not find evidence to support the hypothesis that a greater degree of underreporting of URAI in later recruits occurred. Bradshaw and Danta also note that, in the HIV-infected men recruited from 2001–2003, the hepatitis C virus (HCV) incident rate (IR) declined between 2000–2004 and 2005–2011. However, this was not a statistically significant decline; the 95% confidence intervals (CIs) around the IRs are large and overlap (IR, 6.74 [95% CI, 2.71–10.89] vs 5.16 [95% CI, 2.57–9.23]). Nevertheless, we acknowledge that our finding that HCV incidence did not increase among MSM during this time period is in stark contrast to the 18-fold increase reported in the Swiss HIV Cohort Study (SHCS) [3]. Interestingly, the increase among MSM in the SHCS occurred exclusively between 2008 and 2011. As the SHCS has ongoing enrollment, we will see if the observed HCV increase occurred among a unique group of recent enrollees, and whether this increase continued.

The authors note that the association of syphilis and incident HCV is lost in the non–injection drug use (IDU), non–blood transfusion group in our study, and they assert that this observation is in contrast to associations reported in other studies of HIV-infected MSM. Because >50% of our non-IDU, non–blood transfusion study group was HIV negative, the most appropriate group for comparison in our study is all HIV-infected men among whom, as shown in our Table 5 [1], syphilis was independently associated with incident HCV (relative risk, 2.75 [95% CI, 1.76–4.29]). This argues against the authors’ assertion that the MACS is “a relatively unusual MSM cohort.”

Last, the authors are concerned that HCV antibody–negative recruits who did not have follow-up HCV testing might have been at higher risk for HCV than those with follow-up HCV testing. The proportion of men who reported having had URAI with ≥2 partners prior to enrollment among those included in our study was not different compared to those who did not have follow-up HCV testing (36% vs 34%; P = .39). Because this important marker of sexual exposure was similar among the MSM included in and excluded from our study, we do not believe that the exclusion of these men is likely to have affected the results of our study.

Eric C. Seaberg

Papers

A closer look at hepatitis C clearance in HIV controllers.

Association between Free Testosterone Levels and Anal Human Papillomavirus Types 16/18 Infections in a Cohort of Men Who Have Sex with Men

Hepatitis C Viremia and Diffusing Capacity for Carbon Monoxide in Women With and Without Human Immunodeficiency Virus

GlycA is associated with neuropsychological impairment in men with HIV.

Reply to Bradshaw and Danta