Background Presence of isolated anti-HBc antibody is common in HIV-infected patients in endemic areas and could be caused by prior HBV infection with loss of anti-HBs antibody. The role of vaccination in these patients remains controversial and is based largely on limited and low quality data. We, therefore, conducted this study to determine immunogenicity and safety of 4 vs. 3 standard doses of HBV vaccination in HIV-infected adults with isolated anti-HBc antibody. Methods An open-label, randomized controlled trial was conducted among HIV-infected patients visiting HIV clinic of the Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand between July and September 2017. Inclusion criteria included ≥ 18 years of age, currently on a stable antiretroviral regimen, CD4+ cell count ≥ 200 cells/mm 3 , plasma HIV-1 RNA < 20 copies/mL, and isolated anti-HBc antibody. The participants were randomized to receive either 3 standard doses (20 µg at month 0, 1, 6) or 4 standard-doses (20 µg at month 0, 1, 2, 6) of IM HBV vaccination, and were evaluated for anamnestic response at week 4 and vaccine response at week 28. Results Of the 97 patients screened, 54 (32 male, mean age of 46 years) were enrolled and 27 were allocated to each of the vaccination groups. Anamnestic response occurred in 25.9% vs. 33.3% in 3-dose group vs. 4-dose group, respectively (p = 0.551). The vaccine response rates at week 28 were 85.2% in 3-dose group vs. 88.9% in 4-dose group (p = 1.000); geometric mean titer of anti-HBs antibody at week 28 was 63.8 and 209.8 mIU/mL in 3-dose group and 4-dose group, respectively (p = 0.030). No adverse events were reported. Conclusions An anamnestic response occurred in one-third of Thai HIV-infected patients with isolated anti-HBc antibody who received one dose of HBV vaccination; however, the majority were still unprotected. The use of either 3 or 4 standard-doses of vaccination was highly effective and should be recommended in all HIV-infected individuals with isolated anti-HBc antibody. Trial registration ClinicalTrials.gov; NCT03212911. Registered 11 July 2019, https://clinicaltrials.gov/ct2/show/NCT03212911 Electronic supplementary material The online version of this article (10.1186/s12981-019-0225-3) contains supplementary material, which is available to authorized users.

Background: Recent studies have shown that obstructive sleep apnea (OSA) is common in both obese and nonobese patients with different clinical and polysomnographic features in each group. However, such studies were scarce and diverse, with small sample sizes, and were rarely conducted in Asian populations. Only one trial to date has employed the classification of BMI in adult Asians by WHO criteria which is currently used as a reference based on morbidity risk.Objectives: To compare the clinical, anthropometric and polysomnographic characteristics of non-obese and obese patients with OSA.

BackgroundHIV-infected patients have decreased serological response to HBV vaccination with faster decline of protective antibody (Ab) titer. In those with isolated anti-HBc Ab, the role of vaccination remains controversial. We, therefore, conducted this study aimed to determine immunogenicity and safety of four- vs. three-standard doses HBV vaccination in HIV-infected adults with isolated anti-HBc antibody.MethodsAn open-label randomized controlled trial with 1:1 allocation was conducted among HIV-infected patients attending the Infectious Diseases clinic of the Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand between July and September 2017. Eligibility participants must be ≥18 years old, taking cART, CD4 ≥200 cells/mm3, HIV VL < 20 copies/mL, and positive isolated anti-HBc Ab. The participants were randomized to receive either three-standard-doses (20 µg at Months 0, 1, 6) or four-standard-doses (20 µg at Months 0, 1, 2, 6) IM HBV vaccination and were evaluated for anamnestic response at Week 4 after the first dose and response at Week 28. Predictive factors for anamnestic response and vaccine responders at Week 28 were analyzed.ResultsOf the total of 97 patients screened, 54 participants were enrolled and randomized. Thirty-two participants were male (59.3%) with the mean age of 46 years old. Anamnestic response occurred in 25.9% vs. 33.3% in three doses vs. four doses arm respectively (P = 0.551). After vaccination, the response rates at Week 28 were 85.2% in three doses arm vs. 88.9% in four doses arm (P = 1.000); with 44.4% vs. 63.0% being high-level responders, respectively (P = 0.172). GMT of anti-HBs Ab at Week 28 in three doses arm and four doses arm were 63.8 and 209.8 mIU/mL, respectively, P = 0.030. No adverse events were reported. A younger age (<45 years old) and higher nadir CD4 count (≥100 cells/mm3) were independently predictive factors of anamnestic response with the odd ratio (OR) of 17.4 (95% CI 3.0–102.0) and 21.6 (95% CI 2.7–170.4) respectively. No predictive factors of responders at Week 28 were found.ConclusionIn Thai HIV-infected patients with isolated anti-HBc Ab, anamnestic response occurred considerably with both regimens, but the majority was still unprotected. Hence, a single dose vaccination is insufficient. The usual three-standard-doses vaccination was highly effective with high response rate.Disclosures All authors: No reported disclosures.

We report the first case of Nocardia beijingensis pericarditis in a 32-year-old HIV-infected patient. He presented with cardiac tamponade after failing to respond to treatment for smear-negative pulmonary and pericardial tuberculosis (TB). The pericardial fluid was examined several times before it eventually revealed filamentous branching organisms in Gram and modified acid-fast bacilli stain. The culture grew Nocardia spp. and was identified by 16s rRNA sequencing as N. beijingensis. Eight previously reported cases of Nocardia pericarditis in HIV-infected patients were caused by Nocardia asteroides. All patients had low CD4 cell count (range: 17-239 cells/mm) and 50% of patients were treated for tuberculous pericarditis prior to making the correct diagnosis of Nocardia pericarditis. This report revisits the issue of nocardiosis as a great TB mimicker. It should always be considered in the differential diagnosis among HIV-infected patients suspected of having pericardial TB that is failing treatment.