Purpose: The purpose of this study was to determine the risk factors associated with pneumonia, acute respiratory distress syndrome (ARDS), and clinical outcome among patients with novel coronavirus disease 2019 (COVID-19). Methods: This was a cross-sectional multicenter clinical study. A total of 95 patients infected with COVID-19 were enrolled. The COVID-19 diagnostic standard was polymerase chain reaction detection of target genes of 2019 novel coronavirus (2019-nCoV). Clinical, laboratory, and radiologic results, as well as treatment outcome data, were obtained. ARDS was defined as an oxygenation index (arterial partial pressure of oxygen/fraction of inspired oxygen) 300 mm Hg. Findings: Multivariate analysis showed that older age (odds ratio [OR], 1.078; p ¼ 0.008) and high body mass index (OR, 1.327; p ¼ 0.024) were independent risk factors associated with patients with pneumonia. For patients with ARDS, multivariate analysis showed that only high systolic blood pressure (OR, 1.046; p ¼ 0.025) and high lactate dehydrogenase level (OR, 1.010; p ¼ 0.021) were independent risk factors associated with ARDS. A total of 70 patients underwent CT imaging repeatedly after treatment. Patients were divided in a disease exacerbation group (n ¼ 19) and a disease relief group (n ¼ 51). High body mass index (OR, 1.285; p ¼ 0.017) and tobacco smoking (OR, 16.13; p ¼ 0.032) were independent risk factors associated with disease exacerbation after treatment. Implications: These study results help in the risk stratification of patients with 2019-nCoV infection. Patients with risk factors should be given timely intervention to avoid disease progression. (Clin Ther.

Background:Since the pandemic outbreak of coronavirus disease 2019 (COVID-19), the health system capacity in highly endemic areas has been overwhelmed. Approaches to efficient management are urgently needed. We aimed to develop and validate a score for early prediction of clinical deterioration of COVID-19 patients.

Limited real-world data on dolutegravir (DTG) plus lamivudine (3TC) for HIV-1-infected individuals have been reported. This study aimed to evaluated the real-world efficacy and safety of DTG + 3TC in ART-naïve HIV-1-infected adults in China. This real-world prospective observational cohort study enrolled HIV-1-infected adults receiving ART initiation with DTG + 3TC (D3 group) or tenofovir plus lamivudine and efavirenz (TDF + 3TC + EFV, TLE group) with subgroups of low viral load (LVL, ≤500,000 copies/mL) and high viral load (HVL, >500,000 copies/mL) according to baseline HIV-1 RNA. Efficacy were assessed by proportion of virologic suppression, changes of CD4 + cell count and CD4/CD8 ratio, HIV-1 DNA decay, and safety by symptoms and changes of laboratory indicators at week 4, 12, 24, 36, and 48. Totally 45 participants in D3 group and 95 in TLE group were enrolled. The proportion of HIV RNA < 50 copies/mL were 48.7% (19/39), 84.6% (33/39), 100% (39/39), 100% (39/39) in D3-LVL subgroup at week 4, 12, 24, 48, compared with 1.3% (1/75), 14.7% (11/75), 86.7% (65/75), 96.0% (72/75) in TLE-LVL subgroup, with P < .05 at week 4, 12, and 36. The proportion were 0.0% (0/6), 66.7% (4/6), 83.3% (5/6), 100% (6/6) in D3-HVL subgroup compared with 0.0% (0/20), 5.0% (1/20), 85.0% (17/20), 100% (20/20) in TLE-HVL subgroup, with P < .05 at week 12. No virologic rebound was observed in D3 group. Mean change of CD4/CD8 ratio were higher in D3-LVL versus TLE-LVL subgroup at each scheduled visit ( P < .05), while CD4 + cell counts increased significantly in D3-HVL versus TLE-HVL subgroup at week 4 and 12 ( P < .05). Less complaint of dizziness, insomnia, dreaminess and amnesia, lower elevated level of triglyceride and higher elevated level of creatinine from baseline to week 48 were documented in D3 group ( P < .05). Total HIV-1 DNA decayed along with HIV-1 RNA after DTG + 3TC initiation in both D3-LVL and D3-HVL subgroups. DTG + 3TC achieved virological suppression more rapidly and stably versus TDF + 3TC + EFV in ART-naïve HIV-1-infected adults, with better immunological response and less adverse drug effect, and reduced total HIV-1 DNA effectively. DTG + 3TC is a potent regimen for ART-naïve individuals with HIV-1 infection.

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Objective The detection of dual-positivity for both hepatitis B e antigen (HBeAg) and hepatitis B e antibody (anti-HBe) is not typically performed for patients with hepatitis B virus (HBV). This cross-sectional study was designed to figure out the prevalence of dual-positivity for both HBeAg and anti-HBe (DEP) among hospitalized patients with chronic hepatitis B virus infection (C-HBVI). Patients and Methods Data from 2820 cases with C-HBVI from two centers in China were retrospectively analyzed. Univariate and multivariate logistic regression analyses were undertaken to identify the risk factors for liver fibrosis (LF) and acute-on-chronic liver failure (ACLF). Results There were 165 (5.9%), 688, and 1903 patients in DEP, HBeAg+/anti-HBe-, and HBeAg-/anti-HBe+ groups, respectively. The DEP patients’ median age was 43.6 years old and 71.5% of them were male. They had higher levels of alanine transaminase, total bilirubin, and international normalized ratio. Furthermore, DEP cases had a higher proportion of liver cirrhosis, and it was associated with non-invasive testing of LF, including aspartate transaminase (AST)-to-platelet ratio index (APRI) >1.5 (odds ratio (OR) = 1.96, 95% confidence interval (CI): 1.27–3.03, P = 0.002) and fibrosis-4 (FIB-4) score >1.45 (OR = 2.07, 95% CI: 1.28–3.34, P = 0.003). DEP also contributed to the elevated risk of ACLF (OR = 4.80, 95% CI: 2.02–11.39, P < 0.001). Conclusion DEP cases are at higher risks of LF and ACLF than other patients with HBV infection. A fast diagnosis and an active monitoring of liver diseases for DEP patients are extremely vital.

To improve the curative effect of anti-hepatitis B virus (HBV) drugs, methods such as thymosin and entecavir combination have become a focus of clinical investigation. The aim of this retrospective experimental study was to explore the potential mechanism of action of thymosin a1 (Ta1) combined with entecavir in the treatment of HBV infection. A total of 28 patients with chronic hepatitis B, 29 patients treated with thymosin a1 and entecavir combination, and 15 healthy individuals were enrolled in this study. RT-qPCR was conducted to evaluate the mRNA levels of TLR9 in peripheral blood mononuclear cells (PBMCs). The serum level of TLR9 protein was analyzed by ELISA. The binding of TLR9 gene to the protein H3K9Ac in PBMCs was assessed by chromatin immunoprecipitation, and serum inflammatory factors were detected by Luminex technology. The expression levels of TLR9 mRNA and serum TLR9 protein in patients with HBV infection were significantly lower than those in subjects in the control group before treatment but increased after treatment with the Ta1 and entecavir combination. Moreover, the acetylation protein H3K9Ac was significantly bound to the promoter region of the TLR9 gene in patients with HBV infection treated with the Ta1 and entecavir combination compared to that in patients with HBV infection without treatment. Furthermore, the expression levels of interleukin 6 (IL-6), interleukin 12 (IL-12), interferon gamma, and necrosis factor alpha in patients with HBV infection after the combination treatment were slightly decreased compared to those in patients with HBV infection without treatment. In conclusion, the histone acetylation modification of TLR9 was significantly improved in patients with HBV infection after treatment with the Ta1 and entecavir combination, which elevated the expression of TLR9 at the mRNA and protein levels and further regulated the expression of IL-6, IL-12, and other cytokines.