Publications by authors named "J Stuart Nelson"

6,246 Publications

Blood and genital fluid viral load trajectories among treated and untreated persons with acute HIV infection in Malawi.

J Acquir Immune Defic Syndr 2022 Jan 17. Epub 2022 Jan 17.

Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, USA Lighthouse Trust, Lilongwe, Malawi Department of Population Health Sciences, Duke University School of Medicine, Durham, USA UNC Project, Lilongwe, Malawi FHI 360, Lilongwe, Malawi Indiana University, Richard M. Fairbanks School of Public Health in Indianapolis, Indiana, USA Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA Clinical Pharmacology and Analytical Chemistry Core, UNC Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, USA Division of Epidemiology, Ohio State University, Columbus, USA Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA.

Background: Persons with acute HIV infection (AHI) are highly infectious and responsible for a disproportionate share of incident infections. Immediate antiretroviral therapy (ART) rapidly reduces blood viral loads (VL), but genital VLs after ART initiation during AHI are less well described.

Setting: Lilongwe, Malawi, 2012-2014.

Methods: HIV-seronegative and -serodiscordant persons ≥18 years were screened for AHI (RNA positive), and randomized to standard care, behavioral intervention, or behavioral intervention plus short-term ART (raltegravir/emtricitabine/tenofovir) (1:2:2). Persons who were ART eligible under Malawi guidelines could receive first-line therapy. Blood and genital VLs were assessed at weeks 1, 4, 8, and 12. Fisher's Exact test was used to compare viral suppression by ART status.

Results: 46 persons with AHI enrolled, 17 of whom started ART within 12 weeks. Median blood VL at AHI diagnosis was 836,115 copies/mL. At week 12, 7% (1/14) of those who initiated ART had a blood VL ≥400 copies/mL, compared to 100% (23/23; p<0.0001) of those who did not initiate ART (median VL: 61,605 copies/mL). Median genital VL at week 1 was 772 copies/mL, with 13/22 (59%) having VL ≥400 copies/mL. At week 12, 0/10 (0%) of those who initiated ART had genital VL ≥400 copies/mL, compared to 7/15 (47%) of those who did not initiate ART (p=0.02).

Conclusion: Although highly correlated, VLs in blood and genital fluids occupy discrete biological compartments with distinct virologic dynamics. Our results corroborate the dramatic reduction in both compartments after ART initiation. Increasing AHI screening and rapidly initiating treatment is key to interrupt transmission.
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http://dx.doi.org/10.1097/QAI.0000000000002917DOI Listing
January 2022

Mineralocorticoid Receptor Antagonist Treatment of Established Pulmonary Arterial Hypertension Improves Interventricular Dependence in SU5416-Hypoxia Rat Model.

Am J Physiol Lung Cell Mol Physiol 2022 Jan 19. Epub 2022 Jan 19.

Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, United States.

Treatment with mineralocorticoid receptor (MR) antagonists beginning at the outset of disease, or early thereafter, prevents pulmonary vascular remodeling in pre-clinical models of pulmonary arterial hypertension (PAH). However, the efficacy of MR blockade in established disease, a more clinically relevant condition, remains unknown. Therefore, we investigated the effectiveness of two MR antagonists, eplerenone (EPL) and spironolactone (SPL), after development of severe right ventricular (RV) dysfunction in the rat SU5416-hypoxia (SuHx) PAH model. Cardiac magnetic resonance imaging (MRI) in SuHx rats at the end of week 5, prior to study treatment, confirmed features of established disease including reduced RV ejection fraction, RV hypertrophy, pronounced septal flattening with impaired left ventricular filling and reduced cardiac index. Five weeks of treatment with either EPL or SPL improved left ventricular filling and prevented the further decline in cardiac index compared to placebo. Interventricular septal displacement was reduced by EPL while SPL effects were similar, but not significant. Although MR antagonists did not significantly reduce pulmonary artery pressure or vessel remodeling in SuHx rats with established disease, animals with higher drug levels had lower pulmonary pressures. Consistent with effects on cardiac function, EPL treatment tended to suppress MR and pro-inflammatory gene induction in the RV. In conclusion, MR antagonist treatment led to modest, but consistent beneficial effects on interventricular dependence after the onset of significant RV dysfunction in the SuHx PAH model. These results suggest that measures of RV structure and/or function may be useful endpoints in clinical trials of MR antagonists in PAH patients.
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http://dx.doi.org/10.1152/ajplung.00238.2021DOI Listing
January 2022

Herpes Zoster Presenting As Cutaneous Vasculitis in the Upper Extremity.

Cureus 2021 Dec 13;13(12):e20391. Epub 2021 Dec 13.

Dermatology, Oregon Health & Science University, Portland, USA.

The varicella-zoster virus (VZV), a member of the Herpesviridae family (HHV-3), is the pathogen responsible for causing herpes zoster, the skin eruption known as shingles. This report describes a rare presentation of herpes zoster involving cutaneous vasculitis in the unilateral upper extremity in an immunocompetent patient. Histologic evaluation confirmed a diagnosis of leukocytoclastic vasculitis and yielded a positive VZV immunoperoxidase stain. An approach to histologic evaluation of this case is discussed.
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http://dx.doi.org/10.7759/cureus.20391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754063PMC
December 2021

Measurement of the Sixth-Order Cumulant of Net-Proton Multiplicity Distributions in Au+Au Collisions at sqrt[s_{NN}]=27, 54.4, and 200 GeV at RHIC.

Phys Rev Lett 2021 Dec;127(26):262301

National Research Nuclear University MEPhI, Moscow 115409, Russia.

According to first-principle lattice QCD calculations, the transition from quark-gluon plasma to hadronic matter is a smooth crossover in the region μ_{B}≤T_{c}. In this range the ratio, C_{6}/C_{2}, of net-baryon distributions are predicted to be negative. In this Letter, we report the first measurement of the midrapidity net-proton C_{6}/C_{2} from 27, 54.4, and 200 GeV Au+Au collisions at the Relativistic Heavy Ion Collider (RHIC). The dependence on collision centrality and kinematic acceptance in (p_{T}, y) are analyzed. While for 27 and 54.4 GeV collisions the C_{6}/C_{2} values are close to zero within uncertainties, it is observed that for 200 GeV collisions, the C_{6}/C_{2} ratio becomes progressively negative from peripheral to central collisions. Transport model calculations without critical dynamics predict mostly positive values except for the most central collisions within uncertainties. These observations seem to favor a smooth crossover in the high-energy nuclear collisions at top RHIC energy.
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http://dx.doi.org/10.1103/PhysRevLett.127.262301DOI Listing
December 2021

Disestablishing Hospitals.

J Law Med Ethics 2021 ;49(4):542-551

We argue that concentration of power in religious hospitals threatens disestablishment values. When hospitals deny care for religious reasons, they dominate patients' bodies and convictions. Health law should - and to some extent already does - constrain such religious domination.
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http://dx.doi.org/10.1017/jme.2021.78DOI Listing
January 2021
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