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- Haggblom, A., et al.
(author)
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HIV drug therapy duration; a Swedish real world nationwide cohort study on InfCareHIV 2009-2014
- 2017
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In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 12:2
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Journal article (peer-reviewed)abstract
- Background As HIV infection needs a lifelong treatment, studying drug therapy duration and factors influencing treatment durability is crucial. The Swedish database InfCareHIV includes high quality data from more than 99% of all patients diagnosed with HIV infection in Sweden and provides a unique opportunity to examine outcomes in a nationwide real world cohort. Adult patients who started a new therapy defined as a new 3 rd agent (all antiretrovirals that are not N[t]RTIs) 2009-2014 with more than 100 observations in treatment-naive or treatment-experienced patients were included. Dolutegravir was excluded due to short follow up period. Multivariate Cox proportional hazards models were used to estimate hazard ratios for treatment discontinuation. In treatment-naive 2541 patients started 2583 episodes of treatments with a 3 rd agent. Efavirenz was most commonly used (n = 1096) followed by darunavir (n = 504), atazanavir (n = 386), lopinavir (n = 292), rilpivirine (n = 156) and raltegravir (n = 149). In comparison with efavirenz, patients on rilpivirine were least likely to discontinue treatment (adjusted HR 0.33; 95% CI 0.20-0.54, p<0.001), while patients on lopinavir were most likely to discontinue treatment (adjusted HR 2.80; 95% CI 2.30-3.40, p<0.001). Also raltegravir was associated with early treatment discontinuation (adjusted HR 1.47; 95% CI 1.12-1.92, p = 0.005). The adjusted HR for atazanavir and darunavir were not significantly different from efavirenz. In treatment-experienced 2991 patients started 4552 episodes of treatments with a 3 rd agent. Darunavir was most commonly used (n = 1285), followed by atazanavir (n = 806), efavirenz (n = 694), raltegravir (n = 622), rilpivirine (n = 592), lopinavir (n = 291) and etravirine (n = 262). Compared to darunavir all other drugs except for rilpivirine (HR 0.66; 95% CI 0.52-0.83, p<0.001) had higher risk for discontinuation in the multivariate adjusted analyses; atazanavir (HR 1.71; 95% CI 1.48-1.97, p<0.001), efavirenz (HR 1.86; 95% CI 1.59-2.17, p<0.001), raltegravir (HR 1.35; 95% CI 1.15-1.58, p<0.001), lopinavir (HR 3.58; 95% CI 3.02-4.25, p<0.001) and etravirine (HR 1.61; 95% CI 1.31-1.98, p<0.001). Besides the 3rd agent chosen also certain baseline characteristics of patients were independently associated with differences in treatment duration. In naive patients, presence of an AIDS-defining diagnosis and the use of other backbone than TDF/FTC or ABC/3TC increased the risk for early treatment discontinuation. In treatment-experienced patients, detectable plasma viral load at the time of switch or being highly treatment experienced increased the risk for early treatment discontinuation. Treatment durability is dependent on several factors among others patient characteristics and ART guidelines. The choice of 3 rd agent has a strong impact and significant differences between different drugs on treatment duration exist.
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- Kunze, M, et al.
(author)
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Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe
- 2022
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In: Microorganisms. - : MDPI AG. - 2076-2607. ; 10:7
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Journal article (peer-reviewed)abstract
- There has been an increase in reported TBE cases in Europe since 2015, reaching a peak in some countries in 2020, highlighting the need for better management of TBE risk in Europe. TBE surveillance is currently limited, in part, due to varying diagnostic guidelines, access to testing, and awareness of TBE. Consequently, TBE prevalence is underestimated and vaccination recommendations inadequate. TBE vaccine uptake is unsatisfactory in many TBE-endemic European countries. This review summarizes the findings of a scientific workshop of experts to improve TBE surveillance and vaccine uptake in Europe. Strategies to improve TBE surveillance and vaccine uptake should focus on: aligning diagnostic criteria and testing across Europe; expanding current vaccine recommendations and reducing their complexity; and increasing public education of the potential risks posed by TBEV infection.
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- Kolb, Gundula S., et al.
(author)
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Ecological Stoichiometry and Density Responses of Plant-Arthropod Communities on Cormorant Nesting Islands
- 2013
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:4, s. e61772-
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Journal article (peer-reviewed)abstract
- Seabirds deposit large amounts of nutrient rich guano on their nesting islands. The increased nutrient availability strongly affects plants and consumers. Consumer response differs among taxonomic groups, but mechanisms causing these differences are poorly understood. Ecological stoichiometry might provide tools to understand these mechanisms. ES suggests that nutrient rich taxa are more likely to be nutrient limited than nutrient poorer taxa and are more favored under nutrient enrichment. Here, we quantified differences in the elemental composition of soil, plants, and consumers between islands with and without nesting cormorant colonies and tested predictions made based on ES by relating the elemental composition and the eventual mismatch between consumer and resource stoichiometry to observed density differences among the island categories. We found that nesting cormorants radically changed the soil nutrient content and thereby indirectly plant nutrient content and resource quality to herbivores. In contrast, consumers showed only small differences in their elemental composition among the island categories. While we cannot evaluate the cause of the apparent homeostasis of invertebrates without additional data, we can conclude that from the perspective of the next trophic level, there is no difference in diet quality (in terms of N and P content) between island categories. Thus, bottom-up effects seemed mainly be mediated via changes in resource quantity not quality. Despite a large potential trophic mismatch we were unable to observe any relation between the invertebrate stoichiometry and their density response to nesting cormorant colonies. We conclude that in our system stoichiometry is not a useful predictor of arthropod responses to variation in resource nutrient content. Furthermore, we found no strong evidence that resource quality was a prime determinant of invertebrate densities. Other factors like resource quantity, habitat structure and species interactions might be more important or masked stoichiometric effects.
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- Kolb, Gundula S., et al.
(author)
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Effects of Nesting Cormorants (Phalacrocorax carbo) on Soil Chemistry, Microbial Communities and Soil Fauna
- 2015
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In: Ecosystems. - : Springer Science and Business Media LLC. - 1432-9840 .- 1435-0629. ; 18:4, s. 643-657
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Journal article (peer-reviewed)abstract
- Seabirds act as vectors transporting marine nutrients to land by feeding on fish while nesting and roosting on islands. By depositing large amounts of nutrient-rich guano on their nesting islands they strongly affect island soils, vegetation and consumers. However, few studies have investigated how nesting seabirds affect soil communities. In this study, we investigated how cormorant nesting colonies affect soil chemistry, soil microbes and soil and litter fauna on their nesting islands in the Stockholm archipelago, Sweden. We found that cormorant colonies strongly increase organic soil N and P concentrations, and the effect is stronger close to cormorant nests. Microbial communities were studied by extracting phospholipid fatty acids (PLFA) from the soil. The total amounts of PLFA and the amount of PLFA indicating bacterial biomass were lower on active cormorant islands than on reference islands. Furthermore, PLFA structure and thus microbial community structure differed between cormorant and reference islands. Among ten investigated soil and litter arthropod groups three groups (Thysanoptera, Araneae and Oribatida) showed lower densities and one group (Astigmata) showed higher densities in soils on active cormorant than on reference islands. Some arthropod groups showed strong spatial variation on the cormorant islands. Astigmata, Mesostigmata and Diptera showed higher densities in soil samples close to cormorant nests, whereas Oribatida, Collembola and Hemiptera showed lower densities in litter samples close to cormorant nests than in samples taken 3-20 m away from nests. Overall, the cormorant colonies strongly affected soil ecosystems of their nesting islands, but causal correlations between arthropod densities and soil factors were difficult to reveal. One likely reason may be that nesting cormorant islands are very heterogeneous habitats showing large spatial variation in both soil properties as well as fauna densities.
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