Publications by authors named "James C Shepherd"
Article Synopsis
- The study highlights the need for better TB screening tools among people living with HIV to identify both symptomatic and undiagnosed TB, aiming to improve treatment and care effectively.
- Researchers developed a clinical score for predicting active TB using data from the Botswana XPRES trial, employing logistic regression and random forest machine learning, and validated it across various cohorts in South Africa.
- The predictive model includes factors such as male sex, WHO TB symptoms, smoking history, elevated temperature, low BMI, and severe anemia, and attempts to outperform the existing WHO 4-symptom screen for TB detection.
Background: Clinical scores to determine early (6-month) antiretroviral therapy (ART) mortality risk have not been developed for sub-Saharan Africa (SSA), home to 70% of people living with HIV. In the absence of validated scores, WHO eligibility criteria (EC) for ART care intensification are CD4 < 200/μL or WHO stage III/IV.
Methods: We used Botswana XPRES trial data for adult ART enrollees to develop CD4-independent and CD4-dependent multivariable prognostic models for 6-month mortality.
Background: Undiagnosed tuberculosis (TB) remains the most common cause of HIV-related mortality. Xpert MTB/RIF (Xpert) is being rolled out globally to improve TB diagnostic capacity. However, previous Xpert impact trials have reported that health system weaknesses blunted impact of this improved diagnostic tool.
View Article and Find Full Text PDFBackground: Newly infected subjects acquire a limited number of human immunodeficiency virus type 1 (HIV-1) variants with specific genotypic and phenotypic features from the array of viruses present in a chronically infected transmitting partner.
Methods: We examined HIV-1 envelope sequences from the earliest available serum sample after HIV-1 acquisition in 13 newly infected subjects and from their epidemiologically linked HIV-1-infected heterosexual partner. Samples from both members were collected on the same day in the Rakai Community Cohort Study.
We examined the emergence of CXCR4 (i.e., X4) tropism in 67 male human immunodeficiency virus type 1 (HIV-1) seroconverters from the Multicenter AIDS Cohort Study (MACS) who were selected to reflect the full spectrum of rates of HIV-1 disease progression.
View Article and Find Full Text PDFBackground: The occurrence of human immunodeficiency virus type 1 (HIV-1) superinfection has implications for vaccine development and our understanding of HIV pathogenesis and transmission.
Methods And Results: We describe a subject from the Multicenter AIDS Cohort Study who was superinfected with a dual-tropic (CXCR4/CCR5-utilizing) HIV-1 subtype B strain between 0.8 and 1.
We describe a case of West Nile virus encephalitis in a 54-year-old kidney transplant recipient. The clinical course was rapid and fatal. Serial CSF samples showed an evolving mononuclear pleiocytosis and serial MRIs showed increasing signs of cytotoxic edema in her basal ganglia.
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