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Background 4CMenB appears to be effective in reducing Neisseria gonorrhoeae (Ng) infections. Aims are to assess factors associated with breakthrough rectal Ng after 4CMenB and evaluate clinical and microbiological characteristics of breakthrough infections compared with before vaccination. Methods This was a retrospective study of gay, bisexual, and other men who have sex with men (GBMSM) vaccinated with 4CMenB (2 doses) between 2017 and 2023 at the San Raffaele Scientific Institute for Research, Hospitalization and Healthcare (IRCCS San Raffaele Scientific Institute), Milan, Italy, and tested for rectal Ng. Rectal Ng infection is considered breakthrough if it occurs >1 month after the second 4CMenB dose and with positive nucleic acid amplification test (NAAT) result. Follow-up was from July 2017 (first 4CMenB vaccination) to November 2023 (data freeze). Rectal Ng was screened with both NAAT and gonococcal-specific cultures. Characteristics of individuals with or without breakthrough Ng and of Ng infections before or after 4CMenB were compared using Mann-Whitney and χ2/Fisher tests. Results Overall, 473 GBMSM vaccinated with 4CMenB were included, with a median age (interquartile range) of 43 (37–51) years; 451 of 473 were living with human immunodeficiency virus. The percentage of NAAT-positive rectal Ng swab samples was 76 of 957 (7.7%) after 4CMenB and 51 of 456 (11.1%) before. Breakthrough rectal Ng after baseline were 76 in 57 of 473 people. People with rectal Ng after 4CMenB were younger, more likely to have a previous sexually transmitted infection, and had more sexual partners than those without (all P <.001). Breakthrough rectal Ng infections were less frequently symptomatic (34.2% vs 66.7%; P =.001) and more likely with negative gonococcal-specific culture (55.3% vs 19.6%; P <.001) compared with before vaccination. Conclusions Breakthrough rectal Ng infections after 4CMenB were 76 in 57/473 people, preferentially identified in GBMSM with higher-risk sexual behaviors, were less often symptomatic, and more often with negative gonococcal-specific cultures, suggesting lower infection virulence. [ABSTRACT FROM AUTHOR]

The class I HLA genotype has been widely recognized as a factor influencing HIV disease progression in treatment‐naïve subjects. However, little is known regarding its role in HIV disease course and how it influences the size of the viral reservoir once anti‐retroviral therapy (ART) is started. Here, leveraging on cutting‐edge bioinformatic tools, we explored the relationship between HLA class I and the HIV reservoir in a cohort of 90 people living with HIV (PLWH) undergoing ART and who achieved viral suppression. Analysis of HLA allele distribution among patients with high and low HIV reservoir allowed us to document a predominant role of HLA‐B and ‐C genes in regulating the size of HIV reservoir. We then focused on the analysis of HIV antigen (Ag) repertoire, by investigating immunogenetic parameters such as the degree of homozygosity, HLA evolutionary distance and Ag load. In particular, we used two different bioinformatic algorithms, NetMHCpan and MixMHCpred, to predict HLA presentation of immunogenic HIV‐derived peptides and identified HLA‐B*57:01 and HLA‐B*58:01 among the highest ranking HLAs in terms of total load, suggesting that their previously reported protective role against HIV disease progression might be linked to a more effective viral recognition and presentation to Cytotoxic T lymphocytes (CTLs). Further, we speculated that some peptide‐HLA complexes, including those produced by the interaction between HLA‐B*27 and the HIV Gag protein, might be particularly relevant for the efficient regulation of HIV replication and containment of the HIV reservoir. Last, we provide evidence of a possible synergistic effect between the CCR5 ∆32 mutation and Ag load in controlling HIV reservoir. [ABSTRACT FROM AUTHOR]

Objective: Restoring anti‐JC virus (JCV) immunity is the only treatment of progressive multifocal leukoencephalopathy (PML). Interleukin‐7 is a cytokine that increases number and function of T cells. We analyzed a population of PML patients who received recombinant human IL‐7 (rhIL‐7) to estimate survival and its determinants. Methods: After exclusion of patients with missing data or receiving other immunotherapies, findings from 64 patients with proven PML who received rhIL‐7 between 2007 and 2020 were retrospectively analyzed. Logistic regression was used to analyze variables associated with one‐year survival. Results: Underlying conditions were HIV/AIDS (n = 27, 42%), hematological malignancies (n = 16, 25%), primary immunodeficiencies (n = 13, 20%), solid organ transplantation (n = 4, 6%) and chronic inflammatory diseases (n = 4, 6%). One‐year survival was 54.7% and did not differ by underlying condition. Survival was not associated with baseline characteristics, but with a >50% increase in blood lymphocytes (OR 4.1, 95%CI 1.2–14.9) and CD4+ T cells (OR 5.9, 95%CI 1.7–23.3), and a > 1 log copies/mL decrease in cerebrospinal fluid JCV DNA (OR 7.6, 95%CI 1.6–56.1) during the first month after rhIL‐7 initiation. Side effects were mainly local and flu‐like symptoms (n = 8, 12.5%) and PML‐immune reconstitution inflammatory syndrome (IRIS) (n = 5, 8%). Interpretation: In this non‐controlled retrospective study, survival did not differ from that expected in HIV/AIDS patients, but might have been improved in those with hematological malignancies, primary immunodeficiencies and transplant recipients. RhIL‐7 might have contributed to the increase in blood lymphocytes and decrease in CSF JCV replication that were associated with better survival. ANN NEUROL 2022;91:496–505 [ABSTRACT FROM AUTHOR]

Only toxigenic serogroups O1 and O139 Vibrio cholerae have been associated with widespread cholera epidemics. Other serogroups (non-O1/non-O139 Vibrio cholerae or NOVC) most often cause sporadic gastrointestinal manifestations. Rarely, NOVC can result in severe extraintestinal manifestations in immunocompromised hosts. Although the presence of Vibrio cholerae is well documented in Mediterranean waters, it is not routinely tested in food sources in European countries. Here we report the case of a 46-year-old woman with a history of Von Hippel-Lindau syndrome who had previously undergone major hepatic and pancreatic surgeries and was on Everolimus, which caused neutropenia and mucositis. She was admitted to our emergency department with fever, chills, nausea, and abdominal pain, and was diagnosed with sepsis and acute cholangitis. Empiric piperacillin/ tazobactam was started, and blood cultures later identified non-O1/non-O139 Vibrio cholerae, linked to recent oyster consumption. The ongoing therapy resulted in initial clinical stabilization and microbiological clearance. However, fever persisted, along with the onset of diarrhoea (with negative stool cultures), leukopenia, thrombocytopenia, and elevated CRP levels. Ciprofloxacin was then added to the regimen, resulting in improved condition, fever resolution, normalization of bowel function, relief from abdominal pain, and radiological resolution of cholangitis. She was discharged in stable condition after 15 days of treatment. NOVC systemic infections are rising globally. Physicians should think of this pathogen in patients with risk factors, suggestive symptoms, and seafood ingestion. The literature shows significant heterogeneity in antimicrobial strategies, but association of beta-lactam antibiotic with ciprofloxacin proved to be an effective choice.

Weight gain following the initiation or the switch of antiretroviral therapy (ART) is well documented and mainly associated with some of the most recent drugs, such as integrase strand transfer inhibitors and tenofovir alafenamide. However, limited data have been published on weight trends in ART-experienced people living with HIV (PLWH) with a long exposure to HIV infection and antiretroviral drugs. In our study, we assessed changes in weight after switching ART among PLWH who reported weight gain under a previous regimen.