Temesgen, Zelelem

Abstract Background Increased prevalence of reduced bone mineral density (BMD) is well documented in persons infected with human immunodeficiency virus (HIV), hepatitis C virus (HCV), or both. This study's purpose was to determine if an association exists between dietary calcium intake and BMD in these patients. Methods Participants were individuals with virologically suppressed HIV or untreated HCV monoinfections, those with HIV/HCV coinfection, and noninfected controls. The Hertzler-Frary dietary calcium questionnaire documented calcium intake with calcium amounts based on the US Department of Agriculture nutrient database. BMD was measured at baseline by dual-energy x-ray absorptiometry, and χ2 tests were used to assess the relationship between BMD and infection status. One-way analysis of covariance was used to compare calcium intake data with the prevalence of normal BMD and osteoporosis by infection group. Adjustments were made for race, age, body mass index, and smoking status. Spearman correlation was used to identify relationships between calcium intake from foods/beverages and BMD. Results A total of 452 men were recruited into the study. Osteoporosis and osteopenia were prevalent, but there was no association between infection group and BMD result (χ2(6) = 6.813; P = .34). Only HCV-infected patients with osteoporosis had lower calcium intake than patients with normal BMD (mean difference, 409 mg/d [95% confidence interval, 35–784 mg/d]; P = .03). Conclusions In this study population, dietary calcium intake was correlated with reduced BMD only in patients with HCV monoinfection.

AbstractBackgroundClostridioides difficile infection (CDI) is a significant cause of morbidity and mortality in recipients of solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT). In retrospective single center analyses, severe disease and relapse are common. We undertook an international, prospective cohort study to estimate the response to physician determined antibiotic treatment for CDI in patients with SOT and HSCT.MethodsAdults with a first episode of CDI within the first 2 years of SOT or HSCT were enrolled. Demographics, comorbidities, and medication history were collected, and over 90 days of follow‐up clinical cure, recurrences, and complications were assessed. Logistic regression was used to study associations of baseline predictors of clinical cure and recurrence. Odds ratios (ORs) and 95% confidence intervals (CIs) are cited.ResultsA total of 132 patients, 81 SOT and 51 HSCT (32 allogeneic), were enrolled with a median age of 56 years; 82 (62%) were males and 128 (97%) were hospitalized at enrollment. One hundred and six (80.3%) were diagnosed by DNA assay. CDI occurred at a median of 20 days post‐transplant (interquartile range, IQR: 6–133). One hundred and eight patients (81.8%) were on proton pump inhibitors; 126 patients (95.5%) received antibiotics within the 6 weeks before CDI. The most common initial CDI treatments prescribed, on or shortly before enrollment, were oral vancomycin alone (50%) and metronidazole alone (36%). Eighty‐three percent (95% CI: 76, 89) of patients had clinical cure; 18% (95% CI: 12, 27) of patients had recurrent CDI; global clinical cure occurred in 65.2%. Of the 11 patients who died, two (1.5% of total) were related to CDI. In multivariable logistic regression analyses, the type of initial treatment was associated with clinical cure (p = .009) and recurrence (p = .014). A history of cytomegalovirus (CMV) after transplant was associated with increased risk of recurrence (44% with versus 13% without CMV history; OR: 5.7, 95% CI: 1.5, 21.3; p = .01).ConclusionsAmong adults who develop CDI after SOT or HSCT, despite their immunosuppressed state, the percentage with clinical cure was high and the percentage with recurrence was low. Clinical cure and recurrence varied by type of initial treatment, and CMV viremia/disease was associated with an increased risk of recurrence.