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A Moonshot for Coral Breeding Was Successful – Hakai Magazine

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Wearing a navy-blue polo neck emblazoned with the Florida Aquarium logo, Keri O’Neil hugs a white cooler at Miami International Airport. “Coral babieeeeees,” she says, before letting out a short laugh. Relief. The container holds 10 plastic bottles teeming with thousands of tiny peach-colored specks. Shaped like cornflakes and no more than a millimeter in length, they are the larvae of elkhorn coral, an endangered species that is as characteristic to the reefs of the Florida Keys and the Caribbean as polar bears are to the Arctic or giant sequoias to Sierra Nevada.

With the larvae kept at 27 °C inside their insulated cooler nestled in the trunk of her car, O’Neil drives back to the Florida Aquarium in Tampa, where she works as senior coral scientist at the aquarium’s Center for Conservation. Once there, the larvae begin their metamorphosis from free-swimming specks into settled polyps, the beginnings of those branching, antler-like shapes that define this species. O’Neil and her colleagues provide everything the coral needs for a strong start in life: warm water with a gentle flow, symbiotic algae that find a home inside the coral’s cells, a soft glow of sunlight, and some ceramic squares “seasoned with algae” that act as landing pads for the larvae.

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This time-lapse video shows the development of elkhorn coral embryos in the lab. Video by Kristen Marhaver

The transformation of larvae into polyps was the final step in a coral breeding project that began on the shores of Curaçao, an island off the coast of Venezuela, in the summer of 2018 and involved a cadre of conservationists and scientists who each specialize in one specific stage of coral development. From collection of eggs during mass spawning events to the cryopreservation of sperm, and from fertilization to larval growth, every step had to go swimmingly for the project to have any chance of success. “It’s like the most stressful relay on Earth,” says Kristen Marhaver, a coral scientist at the Caribbean Research and Management of Biodiversity Foundation in Curaçao, who helped start this relay race by collecting eggs during a nighttime dive at a reef that’s a 45-minute drive from her laboratory. As O’Neil was picking up her coral “babies” in Miami, a second team of scientists at Mote Marine Laboratory and Aquarium in Sarasota, Florida, received its own. The pressure on both labs was immense. To fail now would be to drop the baton just before the final straight.

But, if anything, their efforts were too successful; hundreds of larvae settled as translucent and fragile blobs of tissue (each a single polyp) and then started to divide, branching into the clear waters of their shallow, open-top tanks. Elkhorn coral grows an average of five to 10 centimeters per year, a bamboo-like pace for corals in general. To stop them becoming entangled, O’Neil had to cut, separate, and move her colonies to different paddle pool–sized tanks over the course of the next year. “We almost ended up with a six-foot-by-four-foot [1.8-meter-by-1.2-meter] solid piece of elkhorn coral made up of 400 different individuals,” she says. “They were just outgrowing the tanks.”

A juvenile elkhorn coral colony approximately six months old gets its start in a lab at the Florida Aquarium in Tampa, Florida. The colony’s eggs came from coral in Curaçao and its sperm from coral elsewhere in the Caribbean—coral populations that, under normal circumstances, would not normally have mixed in the wild. Photo by Kristen Marhaver

The rows of coral in O’Neil’s tanks are a window into a former world. The reefs of the Florida Keys were once dominated by elkhorn coral. Visiting these islands that curl southward from Florida like the tip of a bird of prey’s beak, biologist, conservationist, and writer—most notably of Silent Spring, but also of several books on the ocean—Rachel Carson peered into the shallows using a “water glass,” an instrument akin to a glass-bottom bucket. Through this simple portal, she saw great stands of “trees of stone,” a forest of coral. Today, after decades of disease, coastal development, and bleaching, over 95 percent of the state’s elkhorn coral have been lost. And this population isn’t just depleted in number, like a forest that’s been felled, but is also impoverished from within. Some reefs in the Keys descend from a single individual that has reproduced via fragmentation—bits break off the parent coral and start a new colony. This mode of reproduction allows corals to spread, but without the genetic mixing that comes with sex, these clones are more susceptible to disturbances such as disease. The coral larvae raised by O’Neil at the Florida Aquarium are different; they are the product of sperm and egg, a shuffling of genes, and the growth of genetically unique clumps of coral. Reintroducing them could provide a boost to the coral’s genetic diversity—a quick stir to the gene pool—and could save a denuded ecosystem. Their reintroduction could also spell its doom.

Hidden inside the genetic code of the Florida Aquarium’s coral is a map of an atypical origin: the eggs collected from Curaçao were fertilized using sperm from the Caribbean, including Florida. Although the same species (Acropora palmata), these coral populations would never breed in the wild. The distance between the two is hundreds of kilometers and contains the island blockade of the Greater Antilles—an impossible journey for any sperm. The coral housed in the Florida Aquarium are the products of human hands, the latest addition to a recent—and often controversial—trend in conservation known as “assisted gene flow,” shuttling existing genetic diversity to new places.

collecting coral eggs

Elkhorn coral spawn only once a year, triggered by the full moon, but estimating the exact time and date of the spawn is tricky. Scientists in Curaçao dove for more than 40 nights before the elkhorn coral they were monitoring finally released their eggs. Photo courtesy of Smithsonian’s National Zoo

No hands have offered more assistance to these coral than those of Mary Hagedorn, senior research scientist at the Smithsonian Conservation Biology Institute, who is based at the University of Hawai‘i at Mānoa. Hagedorn flew to the Caribbean to guide this project from start to finish. It is her research that made this work possible. Since 2004, she has developed cryopreservation techniques that can freeze coral sperm and—just as importantly—keep them fertile upon thawing. Although cryopreservation has been used for IVF in humans and other mammals for decades, it’s only in the last few years that other coral conservationists have adopted Hagedorn’s techniques for coral sperm. At a time when these methodologies are most needed, Hagedorn’s work has matured into a solid science, says Tom Moore, a coral restoration manager at the National Oceanic and Atmospheric Administration at the time of this project and now in the private sector. “I think we’re going to start seeing a lot more of this done in the course of the next few years.”

Without the option to freeze sperm, coral conservationists have been forced to work within the few hours these sex cells remain viable. In Florida, Moore says, scientists from the Lower Keys would drive north to meet colleagues from the Upper Keys and swap sperm samples on the side of the road, fertilizing eggs there and then before the sperm stopped swimming. With the option to freeze sperm using liquid nitrogen, however, samples can be transported long distances—from Florida to Curaçao, for example. Then, when eggs are collected from the reef, the sperm can be thawed and used in concentrations that make fertilization most likely. Hagedorn’s work opens up new possibilities that, just a few years ago, were largely ignored.

Biologists Kendall Fitzgerald and Claire Lager

Biologists Kendall Fitzgerald, left, and Claire Lager, of the Smithsonian Conservation Biology Institute, work in the lab where cryopreservation techniques are used to conserve coral as part of a global coral biorepository. Photo courtesy of Smithsonian’s National Zoo

Self-funded for many years, Hagedorn’s research was nearly stopped altogether in December 2011. Her savings had run out and funders didn’t seem to see the potential of her work. “I was a month away from closing my lab,” she says. Then she received an unexpected call from the Roddenberry Foundation, a philanthropic organization set up in memory of Gene Roddenberry, the writer of Star Trek. Since Hagedorn’s work fit the criteria for bold and unique science, the foundation wanted to fund her research for five years. Since then, her work has grown to include frozen larvae, frozen coral symbiotic algae, and frozen coral fragments, and it has been adopted by labs around the world. To help her cryopreservation methods spread, Hagedorn runs workshops and shares her techniques freely; the instructions to build her equipment can be downloaded and then manufactured with a 3D printer.

As with IVF in humans, coral fertilization is not a perfect science. In a study published in 2017, Hagedorn and her colleagues showed that fertilization rates from frozen coral sperm are significantly lower than from fresh sperm, roughly 50 percent versus over 90 percent. And these figures were based on coral that lived as neighbors on the same reef. The researchers wanted to increase genetic diversity in the future (through assisted gene flow), but it was still unknown whether populations that had been isolated for thousands of years could produce viable offspring, especially after their sperm had been frozen. The idea to breed elkhorn coral from the Florida Keys with those from Curaçao was the most extreme test yet of Hagedorn’s methods. It was a moonshot for coral conservation, says O’Neil. “We wanted to do something that had never been done before.”

Mary Hagedorn

Mary Hagedorn, senior research scientist at the Smithsonian Conservation Biology Institute, has pioneered coral cryopreservation techniques since 2004. Photo courtesy of Smithsonian’s National Zoo

Marhaver thought that they had a five to 10 percent chance of success. To have hundreds of healthy coral now sitting in tanks barely crossed her mind. Conservationists are more attuned to the vibrations of endangerment, extinction, and loss. To have a moonshot succeed is unfamiliar territory. With the impossible now possible, the next hurdle is moving from the lab to the ocean, a leap that not everyone is comfortable with.

As in medical practice, the first rule of restoring ailing ecosystems is primum non nocere, “first, do no harm.” And what concerns Lisa Gregg, program and policy coordinator at the Florida Fish and Wildlife Conservation Commission (FWC), the organization that decides the fate of the Florida-Curaçao coral, is that they aren’t suited to the local conditions of the Florida Keys, a place that Carson referred to as having an atmosphere that is “strongly and peculiarly [its] own.” These islands are formed from sedimentation, while those of Curaçao and the eastern Caribbean are founded on volcanic activity. Plus, the Florida Keys also have their own unique combination of problems, from infectious disease to coastal development, and from hurricanes to coral bleaching. “We have a lot of problems here,” says O’Neil. “And it is quite likely that the corals that are still alive in Florida after everything that’s happened to them are probably the ones that are best suited to living in Florida and providing offspring that may be capable of surviving in Florida.” If Curaçao genes were introduced, they might lead to lower rates of reproduction, shorter life spans, or lowered resistance to local diseases. Imperceptible at first, such “outbreeding depression” can slowly weaken a population, generation by generation. To introduce genes that haven’t experienced the same history could be a ratchet toward extinction.

The risk of such outbreeding depression is very low, however—a doomsday forecast for Florida’s reefs, many conservationists think. “I’m not so concerned that there’s a huge risk of the Curaçao [genes] causing a major detriment to the native Florida population,” says Iliana Baums, head of marine conservation and restoration at the University of Oldenburg, Germany, who has studied elkhorn coral since 1998. “But that’s based on my knowledge of the literature for other species and modeling and so on. I don’t have any direct evidence for that.” Direct evidence would require reintroduction, a catch-22 of conservation; the very thing that is controversial and potentially dangerous is also the route to understanding.

elkhorn coral

Elkhorn coral was once one of the most prolific coral species in the Caribbean and Florida Keys. Raising it in the lab could help boost the species, but since the new colonies are derived from eggs and sperm that would not mix under normal circumstances, their release into the wild is stalled. Photo courtesy of Smithsonian’s National Zoo

Gregg was clear with O’Neil, Marhaver, Hagedorn, and their colleagues from the beginning of this project. “They knew right off the bat … that they were not going to be able to out-plant [the coral]. It was never in question.” The FWC has a “nearest neighbor” policy when it comes to conserving Florida’s coral reefs, she says. “With Acropora palmata, I believe the nearest neighbor would be Cuba or Belize. But other acceptable areas to bring corals in from would be Mexico or the Bahamas. If you’ve got corals coming from Curaçao, that’s leaps and bounds away from Florida.”

After nearly 20 years of research and the near closure of her lab, Hagedorn is tired of waiting. She is sympathetic to the FWC’s approach, but also believes that this large population of captive coral should be introduced—in “a restricted and monitored fashion”—given the critical status of A. palmata. “There’s so little coral in Florida now, it’s just a joke,” she says. In addition to tracking their precipitous decline, scientists have tried to find evidence that new, sexually produced elkhorn coral are settling in the area, but they regularly come back empty-handed. Since this species releases sperm and eggs en masse once a year, the lack of natural recruitment is a worrying sign that such mass spawning events are failing. Warmer waters, pollution, a thick covering of algae, and the rarity of mature coral all add up to prevent new baby coral from settling. Whatever the case, successful sexual reproduction—the fertilization of egg and sperm to create a swimming larva—is so low that it no longer supports this population. “Every year, we seem to lose more [coral] without making more, because sexual reproduction isn’t working,” says Baums. “None of us could’ve imagined that these coral populations would die out this fast. I don’t think any one of us could have really wrapped our heads around that, even 10 years ago … I think we’re at the stage that we need to try something new.”

Even with this precipitous decline, there is still time to try a less extreme version of assisted gene flow, O’Neil says. Now that the Florida-Curaçao experiment has been a success, her team can consider crossing coral from Mexico, the Bahamas, or Cuba—just a relative stone’s throw away—with Florida stock. These populations are able to mix naturally: although sperm can’t survive the journey, the planktonic larvae can travel the current from the Bahamas to Florida so are considered part of the same subpopulation. Gregg says that she would support any elkhorn restoration project that conforms to the FWC “nearest neighbor” policy. Until then, such assisted gene flow will remain limited to laboratories and aquariums.

In December 2021, O’Neil said goodbye to the coral she had raised from peach-colored larvae to hand-sized elkhorn recruits. With the project’s end, they were being transported from the Florida Aquarium to the Mote Marine Laboratory and Aquarium, where they joined the rest of the coral grown as part of this study. Some are being exposed to warmer temperatures to see if they are better able to survive in the warmer waters predicted for the future. Others will be transported to museums and aquariums around the United States. The rest sit patiently and continue to divide, to grow, polyp by polyp. They may never be introduced into the wild, but their mere existence opens a wide-angle vista for coral conservation. If such disparate populations can be crossed and grown by the hundred, almost anything is possible. The next coral babies that O’Neil collects from the airport will have simply traveled a shorter distance in their cooler.

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HIV-Associated Mycobacterium Avium Complex, Oral Candida, and SARS-CoV | IDR – Dove Medical Press

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Background

An unprecedented public health emergency is unfolding worldwide with the coronavirus disease 2019 (COVID-19) pandemic.1 After COVID-19 emerged, concern was voiced regarding its impact on people living with HIV.2 Some of the factors that increase susceptibility to human immunodeficiency virus (HIV) are also relevant for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19.3,4 Certain comorbidities were stronger drivers of COVID-19 outcomes and were associated with an increased risk of death.5

Opportunistic infections (OIs) are a leading cause of mortality in patients with acquired immunodeficiency syndrome (AIDS). Worldwide, tuberculosis (TB) is the predominant cause of death from an infectious disease, causing more deaths than HIV/AIDS. However, the HIV pandemic has worsened the situation not only by leading to the resurgence of TB but also by suppressing the host immune system, which provides an opportunity for infection by non-TB mycobacteria (NTM).6

The most common NTM species that causes disseminated infections in patients with HIV/AIDS is Mycobacterium avium complex (MAC). HIV patients with disseminated MAC infection are at high risk of developing complications and have a higher mortality risk, thus necessitating more active clinical management.7 M. avium is one of the main causes of NTM infection-associated morbidity and mortality in HIV/AIDS patients.8 MAC infections have clinical symptoms similar to active TB infections and are therefore easily mistaken for TB.

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Candidiasis are commensal fungi of the oral mucosa often found in immunocompromised patients and are potential pathogens that can cause an OI. In HIV-1 and TB co-infected patients, oral candidiasis (OC) is found with a prevalence of 35%, and in HIV-1 patients with OC, there is a 2.4 times higher odds of having TB.9

In this report, we retrospectively describe a 23-year-old woman who was diagnosed with HIV 17 years prior. This patient had concurrent SARS-CoV-2, MAC, and OC infections. We present the diagnosis and management of these infections that allowed the patient’s recovery.

Case Presentation

The patient was a 23-year-old woman who had been diagnosed with HIV 17 years prior and had since received standard antiretroviral therapy (ART). Notably, she had switched from first line to simplified dual regimen (abacavir-lamivudine-efavirenz to lamivudine-dolutegravir) due to adverse events. She was diagnosed with TB five months prior, when her sputum smear was positive for acid-fast bacilli and the sputum culture subsequently grew TB. She was treated with rifampin, isoniazid, ethambutol, and pyrazinamide. According to “Chinese Guidelines for HIV/AIDS Diagnosis and Treatment”,10 when she was diagnosed with SARS-CoV-2 infection, she was in the AIDS stage due to poor adherence to antiretroviral medications with an HIV load of <100 viral copies/mL and a CD4+ T-cell count of 7 cells/µL.

On hospital day 1, the patient had a positive PCR test for SARS-CoV-2 in a hospital screening. She was referred to a local hospital with constitutional symptoms, including intermittent fever with chills. She had no cough or expectoration but was diagnosed with anemia and TB 5 months prior. There were no retrievable previous trends to compare.

On hospital day 6, the patient was transferred to the Southern Hospital of Zhengzhou First People’s Hospital. She had fever and chills, her temperature was 39.0°C at admission, and her SPO2 was 100% (without oxygen inhalation). She had density shadows in both lungs but had no respiratory distress and had normal oxygen saturation. The patient was found to have normochromic anemia with a hemoglobin level of 85 g/L. Additional blood test results are presented in Table 1. TB and COVID-19 were managed with azithromycin, moxifloxacin, isoniazid, rifabutin, and ethambutol, and ART was continued with lamivudine and dolutegravir. Anemia was treated by transfusion with suspended red blood cells. On hospital day 8, chest computed tomography (CT) scanning revealed substantial pulmonary lesions (Figure 1).

Table 1 Clinical Laboratory Results at Admission and Throughout the Clinical Course of Infection

Figure 1 CT scanning revealed substantial pulmonary lesions.

On hospital day 13, the patient reported fever (temperature of up to 38.8°C), but no cough, sputum cough, chest tightness, or shortness of breath. Laboratory tests results are presented in Table 1. A diagnosis of disseminated MAC infection was made by two sputum cultures positive for MAC. Co-infection is a high-risk factor for the progression of COVID-19 to severe and the patient was treated with BRII-196+BRII198 monoclonal antibody therapy. MAC was managed with moxifloxacin, azithromycin, rifabutin and ethambutol, sulfamethoxazole given orally this compound also helps to prevent pneumocystis pneumonia (PCP). Thymalfasin was given to improve immunity, low molecular weight heparin calcium was given as an anticoagulant therapy, and the other treatments described above were continued. On hospital day 16, the chest CT scan showed a thin ground-glass density shadow in both lungs, but it was slightly smaller than in previous scans (Figure 2). Laboratory tests showed C-reactive protein (CRP) of 87.6 mg/L. Azithromycin and moxifloxacin were added to the treatment protocol for anti-infection treatment, and amikacin was used as an anti-MAC treatment.

Figure 2 CT scan showed a thin ground-glass density shadow in both lungs, but it was slightly smaller than in previous scans.

On hospital day 27, the patient had intermittent fever and pain in the left abdomen and the blood test results are presented in Table 1. Chest CT scanning was performed, which showed significant improvement of the pulmonary lesions (Figure 3). On hospital day 31, the patient received convalescent plasma therapy.

Figure 3 CT scanning showed significant improvement of the pulmonary lesions.

During days 35–48 of hospitalization, the patient had stable signs and did not have cough, fever, chest tightness, or shortness of breath. The treatments described above were continued.

During days 49–54 of hospitalization, the patient had scattered leukoplakia on the oral mucosa and received fluconazole injection as an antifungal treatment and a sodium bicarbonate gargle. She received a nebulized inhalation of 2 mL of sterilized water and was administered a twice-daily injection of recombinant human interferon α. On hospital day 54, a throat swab was submitted for fungal culture and returned a positive result for Candida albicans infection. The above treatments were continued.

On days 65–67 of hospitalization, two sequential PCR tests for SARS-CoV-2 returned negative results. Three consecutive days of examination showed negative results. The patient was discharged in accordance with the “Diagnosis and Treatment Plan for New Coronavirus Infected Pneumonia (Trial Seventh Edition)”.11

Discussion

A thorough history-taking and examination, as well as the appropriate use of clinical tools, are crucial for identifying concomitant OIs in immunosuppressed patients.

A longer course of COVID-19 has been reported in the setting of co-infection with HIV, particularly with low CD4 cell counts, low CD4+ levels and high levels of viral load influence the lethal progression of COVID-19.7,8,12 SARS-CoV-2 might damage lymphocytes, especially T lymphocytes, and the immune system was impaired during the period of disease.13 HIV-1 infection skewed the SARS-CoV-2 T cell response, HIV-1 mediated CD4+ T cell depletion associated with suboptimal T cell and humoral immune responses to SARS-CoV-2, and a decrease in the polyfunctional capacity of SARS CoV-2 specific CD4+ T cells was observed in COVID-19 patients.14 Our patient had multiple individual risk factors associated with prolonged viral shedding as well as a risk of severe SARS-CoV-2: advanced HIV with a low CD4 count. This maybe the reasons that over two months of intense treatment her CD4+ T cell and total lymphocyte counts remained very low, and her immune system did not improve.

The probability of an OI increases as the CD4+ T cell count declines, especially at counts below 200 cells/µL.15 This patient had switched from first line to simplified dual regimen (abacavir-lamivudine-efavirenz to lamivudine-dolutegravir) due to adverse event. She was in the AIDS stage due to poor adherence to antiretroviral medications and virological failure, with an HIV load of <100 viral copies/mL and a CD4+ T cell count maintained at <100 cells/µL, which may have contributed to the incidence of OIs. MAC are seen more commonly in patients with CD4+ T cell counts of <50 cells/µL.16 The risk of developing MAC infection increases in the presence of other concurrent infections such as TB.17 In AIDS patients, MAC infections often present clinically as disseminated MAC, with several weeks of early symptoms, such as prolonged fever, fatigue, weight loss, abdominal pain, diarrhea, and hepatosplenomegaly. MAC diagnoses are often delayed due to the nonspecific presentation of MAC pulmonary disease and radiological findings that overlap with other pulmonary diseases.18 Patients with risk factors and who meet the diagnostic criteria – which include clinical, radiological, and microbiological criteria – should be considered for treatment. In this case, disseminated MAC infection was diagnosed after two sputum MAC positive cultures over a period of two weeks, indicating that attention should be paid to the diagnosis. Oral candidiasis as a potential harbinger of T and B cell immunosuppression associated with viral infections and COVID-19 may be a risk factor for candidiasis.19 The practitioner should be aware of the importance of unexplained oral candidiasis associated with viral infections. PCP is a life-threatening opportunistic infection that can occur in immunodeficient individuals. The PCP mortality rate can reach 60% if the diagnosis is delayed.20 Early prevention reduces the incidence of PCP. In our case, PCP infection was prevented. This patient’s CD4+ T-cell count was below 200 cells/µL, and sulfamethoxazole was given orally to prevent PCP infection.

In terms of treatment, the use of monoclonal antibody therapy, ART, and broad-spectrum antibiotics is in line with recent literature for the treatment of COVID-19 in patients with impaired immune system functions. Neutralising monoclonal antibody therapies targeting SARS-CoV-2 accelerate reduction in viral loads and reduce the risk of disease progression for outpatient with mild COVID-19.14 Co-infection is a high-risk factor for the progression of COVID-19 to severe and the patient was treated with BRII196+BRII198 monoclonal antibody therapy. The only medication that has not been administered is steroids, which has an important reducing factor in lung injuries and was demonstrated to have better results regarding mortality rate in patients with moderate and severe COVID-19.21,22 However, at the time of the patient’s acquisition of severe immunosuppression and COVID-19, the main studies on the impact of steroids on COVID-19 mortality had not been published. Therefore, the patient did not receive steroids during hospitalization. Considering that our patient was diagnosed SARS-CoV-2 infection in a hospital screening, we speculated that in our patient, COVID-19 had existed for a long time before presentation.

Conclusion

There is a paucity of data on SARS-CoV-2 infection in people with HIV and low CD4 counts. Most studies have been retrospective cohort analyses of patients who are more likely to be virally suppressed and less likely to have CD4 counts of more than 200 cells per μL.9,23 In our cases illustrate that OIs is an important consideration in the presence of one in the setting of co-infection of advanced HIV disease and COVID-19. When treating immunocompromised individuals, some opportunistic infections, such as PCP, should be prevented in the presence of risk factors, these treatments may help reduce clinical symptoms and improve prognosis.

Ethics Statement

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. The institutional approval was not required for the publication of the case details.

Funding

This work was supported by Henan Province COVID-19 Traditional Chinese Medicine Scientific Research Special Project (2022ZYFY02), the Nation Natural Science Foundation of China(U1904153), Science and Technology Research Project of Henan Province (222102310570) and Henan Province Special Project of Traditional Chinese Medicine Scientific research(2019AZB006,2019JDZX2096).

Disclosure

The authors declare that there are no competing interests in this work.

References

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2. Ballester-Arnal R, Gil-Llario MD. [The Virus that Changed Spain: impact of COVID-19 on People with HIV]. El Virus que cambió España: impacto del COVID-19 en las personas con VIH. AIDS Behav. 2020;24(8):2253–2257. Spanish. doi:10.1007/s10461-020-02877-3

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6. Kali A, Charles MP, Noyal MJ, Sivaraman U, Kumar S, Easow JM. Prevalence of Candida co-infection in patients with pulmonary tuberculosis. Australas Med J. 2013;6(8):387–391. doi:10.4066/amj.2013.1709

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10. Hepatitis C Research Group CSoIDCCfDCaP. Chinese guidelines for HIV/AIDS diagnosis and treatment. Chin J AIDS STD. 2021;27(11):1182–1201. doi:10.13419/j.cnki.aids.2021.11.02

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14. Riou C, Stek C, Daroowala R, et al.; HIATUS consortium. Efficacy and safety of two neutralising monoclonal antibody therapies, sotrovimab and BRII-196 plus BRII-198, for adults hospitalised with COVID-19 (TICO): a randomised controlled trial. Lancet Infect Dis. 2022;22(5):622–635. doi:10.1016/s1473-3099(21)00751-9

15. Buchacz K, Lau B, Jing Y, et al. Incidence of AIDS-defining opportunistic infections in a multicohort analysis of HIV-infected persons in the United States and Canada, 2000–2010. J Infect Dis. 2016;214(6):862–872. doi:10.1093/infdis/jiw085

16. Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853–860. doi:10.1056/nejm199803263381301

17. Kaplan JE, Benson C, Holmes KK, Brooks JT, Pau A, Masur H. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(Rr–4):1–207.

18. Daley CL, Winthrop KL. Mycobacterium avium complex: addressing gaps in diagnosis and management. J Infect Dis. 2020;222(Suppl 4):S199–S211. doi:10.1093/infdis/jiaa354

19. Katz J. Prevalence of candidiasis and oral candidiasis in COVID-19 patients: a cross-sectional pilot study from the patients’ registry in a large health center. Quintessence Int. 2021;52(8):714–718. doi:10.3290/j.qi.b1491959

20. Gilroy SA, Bennett NJ. Pneumocystis pneumonia. Semin Respir Crit Care Med. 2011;32(6):775–782. doi:10.1055/s-0031-1295725

21. Horby P, Lim WS, Emberson JR, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693–704. doi:10.1056/NEJMoa2021436

22. Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect −19: the CoDEX randomized clinical trial. JAMA. 2020;324(13):1307–1316. doi:10.1001/jama.2020.17021

23. Yousaf M, Hameed M, Alsoub H, Khatib M, Jamal W, Ahmad M. COVID-19: prolonged viral shedding in an HIV patient with literature review of risk factors for prolonged viral shedding and its implications for isolation strategies. Clin Case Rep. 2021;9(3):1397–1401. doi:10.1002/ccr3.3786

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AIDS day walk in North Battleford aims to 'banish that stigma' – Saskatoon Star-Phoenix

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In 2021, over 200 new cases of HIV were diagnosed in Saskatchewan — while testing, treatment and outreach were reduced due to COVID-19.

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On World AIDS Day, advocates in the Battlefords gathered to raise awareness about how the virus affects people in their community — and how people can get help and treatment, if they need it. 

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“HIV is completely preventable in today’s society, with all the advances in medication,” said Battle River Treaty 6 Health Centre’s HIV project coordinator, Cymric Leask. “But due to a lot of intersecting factors — especially due to COVID — in the past couple of years, our HIV numbers have skyrocketed.”

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In 2021, more than 200 new cases of HIV were diagnosed in the province — even while testing, treatment and outreach were reduced during the height of the COVID-19 pandemic.

Saskatchewan has the highest rate of new HIV infections in Canada, and has had the highest annual rate in the country for more than a decade. 

The proportion of new HIV cases in rural areas is rising, too. 

“Here up north, there are such large barriers to access to care,” said Leask. “We do have some great resources here in North Battleford … but it’s still very hard to access the proper care for HIV.”

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For example, getting started on HIV medication requires a visit with a communicable disease doctor — but there is no communicable disease doctor based in the Battlefords. Instead, that doctor visits the community only once every four months. 

Another barrier Leask has found is that many people still have an outdated understanding of what HIV is, who is at risk and how treatment works. 

“Especially here in rural areas, it’s stigmatized as something that only affects gay or bisexual men — men who have sex with men,” Leask said. 

Today in Saskatchewan, men and women are diagnosed with HIV at almost equal rates, and two thirds of new cases are passed through injection drug use. 

Treatments are much easier to manage than they used to be; some only involve taking one pill a day.

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But the enduring stigma around HIV makes it harder for people to find community and support. 

“People don’t talk about it,” said Jackie Kennedy, executive director of the Battlefords Indian and Métis Friendship Centre. “I think they’re afraid to. A lot of people don’t disclose that information (about their HIV status) because they are afraid to be judged.”

As more people continue to be diagnosed with HIV in Saskatchewan every year, groups and organizations in the Battlefords are working hard to make it easier for people to get testing, treatment, information and harm reduction supplies. 

“We want to banish that stigma of how it used to be,” said Leask. “It’s not like that anymore.”

— Local Journalism Initiative

  1. Katelyn Roberts has been sounding the alarm about the growing toll of syphilis on young, vulnerable women in the community.

    Sask. babies born with syphilis, HIV show gaps in prenatal care: advocates

  2. Melissa St. Denis is a peer mentor at the Persons Living With AIDS Network of Saskatchewan. She was diagnosed with HIV 13 years ago.

    ‘Nothing has changed’: The roots of Saskatchewan’s HIV crisis

  3. NORTH BATTLEFORD,SK--OCTOBER 02/2019-9999- A vending machine for harm reduction supplies located out of the Friendship Centre in North Battleford, SK on Wednesday, October 2, 2019.

    North Battleford uses vending machine in fight against HIV

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Health

Acting MOH urging residents to get flu shot – Simcoe Reformer

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Haldimand-Norfolk’s acting medical officer of health is urging residents to get their flu shot as soon as possible.

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“The hospital system in Ontario is currently overwhelmed with individuals seeking care for influenza and other respiratory viruses,” Dr. Matthew Strauss said Thursday. “There is strong evidence that influenza vaccination can prevent trips to the ER (emergency room) for flu.

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“I strongly recommend that you get your flu shot ASAP on this basis, particularly if you are in a high risk group.”

Flu shots are available through local pharmacies and health care providers. Children six months to two years can only get their flu shot from a doctor or nurse practitioner.

Those in the high-risk group for complications and hospitalization because of the flu include: babies and children under five; people 65 and older; people who are pregnant; people with underlying health conditions and residents of nursing homes and other chronic care facilities.

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The Haldimand-Norfolk Health Unit on Thursday said it has received a significant number of positive lab results related to influenza in recent weeks.

The health unit has received notification of 141 lab-confirmed flu cases in Haldimand or Norfolk residents between Oct. 11 and Nov. 29. During the same period of the 2019-2020 flu season there was just one confirmed case in Haldimand or Norfolk.

The flu is a virus that affects the nose, throat and sometimes the lungs. Although some who get the flu will not have any symptoms or suffer mild illness, others, especially the elderly or young children, can become seriously ill from the flu.

The virus spreads by droplets from coughs or sneezes from someone who is sick with the flu. As well, it can spread if someone touches surfaces where these droplet have landed and then they touch their mouth, nose or eyes.

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Steps to protect yourself from the flu include getting vaccinated each year. Other measures including staying home and way from others if you feel sick, improving ventilation in indoor and shared spaces and frequent hand-washing with soap, water or hand sanitizer.

Washing your hands before touching your eyes, nose or mouth is also beneficial.

The health unit also recommends cleaning and disinfecting frequently touches surfaces and objects.

Clean and disinfect frequently touched surfaces and objects.

Meanwhile, anyone with symptoms of a respiratory illness should stay home until the fever subsides and symptoms have been improving for at least 24 hours and 48 hours if you have had nausea, vomiting or diarrhea.

Those with symptoms should not be visiting people in hospitals, retirement, long-term care homes or any facilities that includes people at higher risk of illness. Those experiencing severe or worsening symptom or in a high-risk group should seek medical attention.

For more information about the influenza virus and the flu shot, visit www.hnhu.org/ .

Vball@postmedia.com

twitter.com/EXPVBall

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Postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. Comments may take up to an hour for moderation before appearing on the site. We ask you to keep your comments relevant and respectful. We have enabled email notifications—you will now receive an email if you receive a reply to your comment, there is an update to a comment thread you follow or if a user you follow comments. Visit our Community Guidelines for more information and details on how to adjust your email settings.

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