記述言語：英語   掲載種別：研究論文（学術雑誌）  

HIV-associated multicentric Castleman disease (HIV-MCD) is a rare, life-threatening lymphoproliferative disorder featuring systemic inflammation and marked lymphadenopathy. HIV-MCD is characterized by a human herpesvirus-8 (HHV-8) infection, with an increasing incidence despite advances in antiretroviral therapy (ART). Although HHV-8 viremia is a recognized indicator of disease recurrence, the necessity of intervention for low-level viremia reactivation remains unclear. We present a case of a man with HHV-8-associated HIV-MCD and Kaposi sarcoma (KS) who achieved a prolonged remission despite occasional episodes of low-level viremia. A 58-year-old man with untreated HIV infection presented with fever, night sweats, and fatigue. Histopathological analysis confirmed the diagnosis of HIV-MCD with KS. He received rituximab, liposomal doxorubicin, and ART which induced remission. The patient was followed for 120 weeks with serial monitoring of HHV-8 DNA levels. Although occasional viremia was observed, no relapse occurred. When mild HHV-8 reactivation occurred post-therapy without clinical relapse, we avoided unnecessary treatments with potential drug-related toxicities. No established prevention for MCD flares exists, and prolonged rituximab or valganciclovir use risks pulmonary and hematologic toxicity. Thus, HHV-8 DNA monitoring and selective interventions seem practical. Timely diagnosis and immunochemotherapy, including rituximab and liposomal doxorubicin, are critical for the management of HIV-MCD with concurrent KS. This combination mitigated KS progression. Successful management of HIV-MCD requires early recognition and administration of ART and targeted therapies, which can result in sustained remission. Close HHV-8 DNA monitoring and clinical assessment minimize the need for additional treatment, underscoring the importance of balancing efficacy and safety in individualized HIV-MCD management.

DOI： 10.1016/j.jiac.2025.102806

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Bacterial sexually transmitted infections (STIs) like syphilis, chlamydia and gonorrhoea are often asymptomatic but can cause severe complications, including infertility and vertical transmission in cisgender women, particularly female sex workers (FSWs). Sex work is strongly associated with syphilis, with FSWs representing 38% of syphilis cases among Japanese women in 2021. Despite doxycycline's proven effectiveness in preventing bacterial STIs, its efficacy in high-risk cisgender women remains inconclusive, highlighting the need for targeted STI prevention strategies in this population. OBJECTIVES: We investigated the effectiveness of doxycycline pre-exposure prophylaxis (doxyPrEP) in preventing STIs and its impact on vaginal flora among FSWs. PARTICIPANTS AND METHODS: This retrospective study included 40 FSWs aged ≥18 years who initiated doxyPrEP (100 mg/day) for STI prevention at a private clinic in Tokyo, Japan, between 1 October 2022 and 14 November 2023. Incidence rate ratios (IRR) for chlamydia, gonorrhoea, syphilis, bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC) were estimated using fixed-effects Poisson regression models. Adherence, side effects, and satisfaction were evaluated through follow-up clinical evaluations. RESULTS: Overall STI incidence significantly declined from 232.3 to 79.2/100 person-years following doxyPrEP initiation (IRR = 0.33, P = 0.020). The reduction in chlamydia showed marginal statistical significance (IRR = 0.35, P = 0.056), and syphilis cases dropped to zero. Gonorrhoea, BV, and VVC incidence showed no significant changes. Follow-up clinical evaluations indicated high adherence to doxyPrEP, no serious adverse events, and high satisfaction with doxyPrEP. CONCLUSIONS: DoxyPrEP significantly reduced the overall STI incidence among FSWs without increasing other vaginal infections.

DOI： 10.1093/jacamr/dlaf054

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease triggered by the reactivation of JC virus (JCV) in individuals with immunodeficiency, particularly those with untreated human immunodeficiency virus (HIV) infection. This case report describes a 46-year-old HIV-positive man who initially presented with neurological symptoms and was incorrectly diagnosed as cerebral infarction. Although standard real-time polymerase chain reaction (PCR) testing for JCV in cerebrospinal fluid (CSF) at a commercial laboratory was negative, neuroimaging and clinical suspicion prompted ultrasensitive PCR testing at a national laboratory. This test detected a low viral load of JCV (28 copies/mL), confirming the diagnosis of PML. The patient underwent treatment with antiretroviral therapy and corticosteroids to prevent immune reconstitution inflammatory syndrome; however, his neurological symptoms persisted. This case highlights the importance of ultrasensitive CSF JCV testing for early PML diagnosis when standard PCR tests are inconclusive, particularly in HIV patients with atypically low JCV levels. It also highlights the diagnostic challenges of PML and emphasizes the clinical value of advanced PCR techniques for timely and accurate diagnosis in similar cases.

DOI： 10.1016/j.idcr.2025.e02229

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記述言語：英語  

DOI： 10.1016/j.alit.2022.03.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The diagnostic accuracy of the interferon-gamma release assay (IGRA) in immunosuppressed patients remains unclear. METHODS: A systematic review and meta-analysis were performed for diagnostic test accuracy of IGRA in tuberculosis (TB) infection among people living with HIV (PLWHIV). Summary estimates of sensitivity and specificity were calculated using both univariate and bivariate models. RESULTS: The meta-analysis included 45 of the 1,242 first-screened articles. The total number of PLWHIV was 6,525; 3,467 had TB disease, including 806 cases of LTBI and 2,661 cases of active TB. The overall diagnostic odds ratio (DOR) of IGRA in the diagnosis of TB disease was 10.0 (95% confidence interval (CI) 5.59, 25.07), with an area under the curve (AUC) of 0.729. The DOR was better for QFT (14.2 (95%CI 4.359, 46.463)) than T-SPOT (10.0 (95%CI 3.866 26.033)). The sensitivity and specificity of QFT and T-SPOT were 0.663 (95%CI 0.471, 0.813), 0.867 (95%CI 0.683 0.942), and 0.604 (95%CI 0.481, 0.715), 0.862 (95%CI 0.654, 0.954), respectively, in the bivariate model. The sensitivity of IGRA in the diagnosis of LTBI was 0.64 (95%CI 0.61, 0.66). CONCLUSION: IGRA was useful in the diagnostic of TB disease in PLWHIV, and QFT showed a better tendency of DOR than T-SPOT. IGRA showed a limited effect to rule out LTBI in PLWHIV.

DOI： 10.1007/s15010-022-01789-9

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総ページ数：xx, 299p   記述言語：日本語

CiNii Books

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記述言語：日本語   出版者・発行元：(一社)日本感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本エイズ学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(公財)性の健康医学財団  

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記述言語：日本語   出版者・発行元：(一社)日本エイズ学会  

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開催年月日： 2024年7月

記述言語：英語   会議種別：口頭発表（一般）  

Selected for the Official Scientific Highlights Press Conference at IAS 2024

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執筆者：本人以外 

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執筆者：本人以外 

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