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Lymphocytic infiltration of the salivary and lachrymal glands is a hallmark of primary Sjögren's Syndrome (PSS). Chronic inflammation leads to progressive destruction of the glands resulting in dryness of the eyes and mouth termed sicca. The course and pace of sicca development in PSS is elusive. To explore the effect of symptom duration on sicca and disease activity. Data of patients from the PSS registry of the Medical University of Graz fulfilling the 2016 ACR/EULAR classification criteria for PSS were analysed. We analysed disease duration and total duration of sicca symptoms, Schirmer's test, unstimulated salivary flow test (USF), stimulated salivary flow test (SSF) and ESSDAI (EULAR Sjögren's Syndrome disease activity index), Evaluators Global Assessment (EGA), and focus score of the initial lip salivary gland biopsy. In addition, salivary gland ultrasound (SGUS) was performed using the De Vita scoring system. Free light chains (FLC) ĸ and λ, IgG, rheumatoid factor (RF) IgA were determined. The patient's perspective was analysed by ESSPRI and PSS-QoL. Data from 159 PSS patients were analysed, of whom 92.6% (n=148) were female. The mean age was 59.3±12.2 years (± standard deviation), with a mean disease duration of 5.5±5.4 years and a mean sicca duration of 11.6±7.4 years. Interestingly, results of USF, SSF, and Schirmer's Test did not decrease with duration of disease or sicca. The lack of correlation was probably caused by a subset of patients in whom glandular function remained stable 10 to 33 years after the onset of sicca. We defined this subgroup of patients by an SSF >0.5ml/min and with a symptom duration >10 years (SFSD10). 19.5% (n=31) of our PSS patient were categorised into this group. SFSD10 showed a significantly higher Schirmers test (median 0 (0-35] vs 3[3-35], p<0.01), lower ESSPRI-dryness (7 [1-10] vs. 5[1-10], p<0.05), PSS-QoL dryness (11[2-22] vs. 8 [3-15], p<0.01), lower IgG (15.5 [7.4-38.1] vs. 11.2 [6.5-30.5], p<0.05) and FLC-K (25 [3.9-134] vs. 20.2 [10.3-63.6], p<0.05) compared to non-SFSD10-group. SGUS De Vita score was significantly lower in the SFSD10 subgroup (median 1 [0-2] vs. 2 [1-3], p=0.045). We found no difference in ESSDAI, focus score, antibody status, pain, fatigue or HRQL between the two groups. Our results indicate the presence of a subgroup of PSS patients with preserved glandular function despite long-standing disease. NIL. NIL. None Declared.

Background:Giant cell arteritis (GCA) is an immune-mediated granulomatous vasculitis affecting large and medium-sized vessels. Vascular ultrasound, the diagnostic gold standard, has limitations in evaluating the aorta. Therefore, positron emission tomography-computer tomography (PET-CT) with [18F]FDG has emerged as a diagnostic alternative. However, interpretation can be challenging as glucose metabolism also occurs in vascular remodeling. The novel radiotracer [68Ga]Ga-DOTA-Siglec-9 could improve PET-CT diagnostic capabilities. Early studies in animals and humans have validated its safety, tolerability, and potential efficacy in identifying inflammation. Siglec-9 is the leukocyte ligand for vascular adhesion protein 1 (VAP-1). Under physiological conditions, VAP-1 resides in intracellular vesicles within various cell types, including endothelial cells. Inflammatory stimuli prompt its translocation to the endothelial cell surface, enabling immune cell adhesion and migration. This upregulation of VAP-1 during inflammation renders [68Ga]Ga-DOTA-Siglec-9 PET-CT particularly interesting for GCA.Objectives:Evaluating [68Ga]Ga-DOTA-Siglec-9 PET-CT for Disease Activity Detection in Giant Cell Arteritis.Methods:We recruited a patient with recurrent GCA disease activity. The patient underwent a [68Ga]Ga-DOTA-Siglec-9 PET-CT scan with an injection of 120 MBq [68Ga]Ga-DOTA-Siglec-9. Fifty-one minutes post-injection, we conducted a low-dose CT for attenuation correction and a whole-body PET scan (one minute/ bed). We also used standard imaging methods, such as vascular ultrasound for the temporal, facial, axillary, carotid, and vertebral arteries, along with aortal MRI and routine laboratory tests.Results:A 90-year-old male patient with GCA, diagnosed in 2018, was enrolled. The patient reported recurrent GCA symptoms, including bitemporal headaches and night sweat. At the time of scan, he received methotrexate 15 mg per week and a daily dose of 2 mg prednisolone. His C-reactive protein level was elevated at 21 mg/l. [68Ga]Ga-DOTA-Siglec-9 PET scan revealed increased tracer uptake (SUVmax) in the subclavian artery (2.5), aortic arch (2.9), and heart (2.9), in contrast to an uptake of 1.5 in the liver (Figure 1). Notably, the increased uptake in the descending aorta (3.5) abruptly diminished to 2.2 when passing the diaphragm, with no changes in vessel caliber observed in CT (Figure 1). Vascular ultrasound and MRI did not reveal any pathological findings (data not shown). The injection of [68Ga]Ga-DOTA-Siglec-9 was well tolerated.Figure 1.Enhanced [68Ga]Ga-DOTA-Siglec-9 uptake in aortic and subclavian regions of a giant cell arteritis patient in positron emission tomography imagingWhole-body PET images of GCA patient (male, 90 years old) after intravenous injection of 120 MBq of [68Ga]Ga-DOTA-Siglec-9. Distribution of [68Ga]Ga-DOTA-Siglec-9 51 min after injection, based on imaging for one minute per bed position, revealed increased uptake in projection on the aortic and subclavian vessels and the heart. The increased uptake in the descending aorta diminishes abruptly while passing the diaphragm, without any caliber jump in the CT images.Conclusion:This study presents the first application of [68Ga]Ga-DOTA-Siglec-9 PET-CT in a GCA patient. PET-CT imaging demonstrated increased tracer uptake in the subclavian artery and aortic arch, with a localized and abrupt reduction. Notably, there were no corresponding findings in conventional imaging. We hypothesize that [68Ga]Ga-DOTA-Siglec-9 PET-CT might offer unique potential for precise, localized mapping of affected vascular tissue in GCA, especially during relapse. This could revolutionize the current diagnostic approach, leading to more targeted strategies for monitoring disease activity. Given these encouraging findings, larger scale studies are essential to fully elucidate the potential role of [68Ga]Ga-DOTA-Siglec-9 PET-CT in the diagnostic landscape of GCA.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Juvenile localised scleroderma (jLS) is a rare rheumatic disease in children characterized by inflammation and fibrosis in the skin [1, 2]. The cause and pathogenesis of jLS remain unclear, and both skin lesions and possible extracutaneous involvement may result in functional impairment and growth disturbances [2]. The treatment options to cure jLS are limited [3].In recent years, omics technologies have been used to identify novel biomarkers in different diseases [4, 5]. Among the different omics technologies, metabolomics and lipidomics provide snapshots of the metabolic network.Objectives:We aim to identify biomarkers and treatment targets for jLS using metabolomics and lipidomics.Methods:Children with jLS and age-matched controls were recruited at Bambino Gesù Children’s Hospital, Roma, Italy. The characteristics of the participants are shown in Table 1.Plasma samples from 9 controls and 12 patients with jLS (before treatment initiation and 17 months after treatment) were sent to Swedish Metabolomics Center, where liquid chromatography–mass spectrometry and gas chromatography–mass spectrometry were performed (Figure 1A). Peak intensities were recorded, and the data analysis was performed using Metaboanalyst 5.0 and Graphpad Prism 10 software. Pathway enrichment bubble plots were generated using SRplot [6]. Mann-Whitney test was used to compare healthy control and baseline patient groups, and Wilcoxon test was used to compare differences between baseline and treated patients.Results:In total, 250 metabolites and 194 putative lipids were annotated (Figure 1A). Patients at baseline had significantly lower peak intensities of lenticin, 3-hydroxybutyrylcarnitine, 1-dodecanoyllysophosphatidylcholine, phosphatidylcholine (PC) 38:6 and 40:9, and phosphatidylserine (PS) 38:1 as well as significantly higher peak intensities of L-tyrosine, phenylpyruvic acid, (3-hydroxyphenyl)hydracrylate, and cortisol compared to controls (Figure 2B). After treatment, peak intensities of adenosine monophosphate, hypoxanthine, 3-phosphoglyceric acid, lysophosphatidylcholine (LPC) 18:2, Cholesteryl Octanoate (CE 8:0), and 2-Hydroxylauroylcarnitine (CAR 12:0) were decreased, whereas peak intensities of L-octanoylcarnitine and eleven molecular species of triacylglycerols were increased compared to baseline patients (Figure 2D). The top enriched pathways are shown in Figure 2C and 2E.Conclusion:We have described the metabolic profile in blood of children with jLS for the first time. Children with jLS show a distinct metabolic profile compared to healthy children, especially in tyrosine-related pathways. Compared to baseline levels, the metabolism of several amino acids was altered after treatment, and the energy storage function might be modified as eleven molecular species of triacylglycerols were found decreased.REFERENCES:[1] Zulian, F., et al., Consensus-based recommendations for the management of juvenile localised scleroderma. Ann Rheum Dis, 2019. 78(8): p. 1019-1024.[2] Li, S.C. and R.J. Zheng, Overview of Juvenile localized scleroderma and its management. World J Pediatr, 2020. 16(1): p. 5-18.[3] Li, S.C., Treatment of juvenile localized scleroderma: current recommendations, response factors, and potential alternative treatments. Current Opinion in Rheumatology, 2022. 34(5): p. 245-254.[4] Puentes-Osorio, Y., et al., Potential clinical biomarkers in rheumatoid arthritis with an omic approach. Autoimmunity Highlights, 2021. 12(1).[5] Xiao, Y.A., et al., Multi-omics approaches for biomarker discovery in early ovarian cancer diagnosis. Ebiomedicine, 2022. 79.[6] Tang, D., et al., SRplot: A free online platform for data visualization and graphing. PLoS One, 2023. 18(11): p. e0294236.Table 1.Characteristics of the participantsCharacteristicsPatientsControlsN129Age, years10±410±4Females, n (%)6 (50)8 (89)Follow-up, months17±3Treatment:Prednisolone, n (%)10 (83)Methotrexate, n (%)12 (100)Tocilizumab, n (%)2 (17)Figure 1.Study design (A), volcano plot of all the annotated metabolites and lipids (B, D), metabolic pathway analysis with the most changed metabolites (C, E).Acknowledgements:Participants who donated the blood samplesDisclosure of Interests:Yuan Zhang: None declared, Angela Aquilani: None declared, Rebecca Nicolai: None declared, Fabrizio De Benedetti Speaker for Novartis and SOBI, Emiliano Marasco: None declared, Cristina Maglio: None declared.

The use of diagnostic laboratory tests is increasing worldwide. Improper test utilization (ITU) is a common problem for all healthcare systems as it costs substantial expenses for the health systems and impacts optimal patient care. The present small-scale survey aims to highlight the current practice of ITU among the labs and physicians, and investigate the actions of diagnostic laboratories towards ITU, and identify the reasons affecting test ordering decisions among physicians. A cross sectional study based on two different surveys was developed and distributed from March 2017 to April 2017 to laboratory supervisors and physicians (clinicians) at Hamad Medical Corporation (HMC), Qatar. Fourteen laboratory supervisors and eighty-nine physicians were surveyed about improper test utilization practices. The overall results are descriptive data. The overall proportion of improperly utilized tests detected by the laboratory supervisors were 50.0%, 35.7%, and 14.3% for overused, misused, and underused lab tests, respectively. Among the physicians, 91% used the electronic ordering template to select the appropriate tests. Moreover, 78.7% of the physicians used the clinical guidelines, while 73% were not employing the laboratory handbook. Furthermore, 95.5%% of the physicians preferred to get feedback about inappropriate tests, while 51.1% were not receiving any, and 40.9% were rarely receiving. Finally, 67.4% were unaware of the tests' costs among surveyed physicians, and 63.6% showed a willingness to reduce their orders if the cost was high and unnecessary. The physician's and the laboratories' communication were inadequate and not systematized, causing ITU practices. The improvement strategy should focus on the communication between clinical labs and physicians and enhance physician implementation to order appropriate lab tests. This could be achieved by conducting legitimate educational methodologies, continuous feedback reviews, ongoing audits, executing health information technology instruments, engaging laboratory practice guidelines, and applying demand management and testing algorithms.

Despite intensive lipid-lowering interventions, patients treated with statins develop atherosclerotic cardiovascular disease (ASCVD), and these patients have an increased risk of developing recurrent cardiovascular events during follow-up. Therefore, there is a need to focus on the residual risks in patients in statin therapy to further reduce ASCVD. The aim of this study was to retrospectively investigate the 10-year trend (2011–2019) regarding changes in polyunsaturated fatty acids (PUFAs) in patients with acute coronary syndrome (ACS) in a single center. We included 686 men and 203 women with ACS admitted to Kagawa Prefectural Central Hospital. Plasma PUFAs, including eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), and dihomo-γ-linolenic acid (DGLA), were measured at admission for suspected ACS. A secular decreasing trend in the levels of EPA and DHA and the EPA/AA ratio, but not of AA and DGLA, was observed. The analyses based on age (>70 or <70 years) and sex showed that the decreasing trend in the levels of EPA and DHA did not depend on age and remained significant only in men. Further studies are needed to obtain robust evidence to justify that the administration of n-3 PUFA contributes to the secondary prevention of ACS.

The classical Muslim scholarly tradition produced an assortment of literature on different religions including a considerable number of descriptive studies, a phenomenon that leaves imposing questions. Most importantly, how a pre-modern civilization was able to generate a tradition of descriptive scholarship on different religions in the absence of conditions such as the western modernity that supposedly factored the emergence of the modern academic study of religion needs to be explored. The current paper ventures to answer this question. It argues that certain features of the Qur’ānic worldview, such as the repeated invitation to observe the signs of God in time and space through travel in the land/across the world and to ponder upon the history of various nations coupled with the exhortation to use reason generated curiosity about different civilizations of the world as well as their religious heritage. Moreover, the Qur’ānic view of the universality of the religious phenomenon as a divine plan also encouraged a sober disposition towards religious others in cases under discussion. On the other hand, the meticulous historiographical techniques and methods for the interpretation of texts developed by Muslim historians, theologians, and jurists afforded the needed methodological apparatus for the said undertaking. The current paper further concludes that the same epistemology and methodological foundations can be appropriated according to/keeping in view the needs of the time to promote a credible study of religion/s in contemporary Muslim societies

ObjectiveThe 2016 Global Strategy on Human Resources for Health: Workforce 2030 projected a global shortage of 18 million health workers by 2030. This article provides an assessment of the health workforce stock in 2020 and presents a revised estimate of the projected shortage by 2030.MethodsLatest data reported through WHO’s National Health Workforce Accounts (NHWA) were extracted to assess health workforce stock for 2020. Using a stock and flow model, projections were computed for the year 2030. The global health workforce shortage estimation was revised.ResultsIn 2020, the global workforce stock was 29.1 million nurses, 12.7 million medical doctors, 3.7 million pharmacists, 2.5 million dentists, 2.2 million midwives and 14.9 million additional occupations, tallying to 65.1 million health workers. It was not equitably distributed with a 6.5-fold difference in density between high-income and low-income countries. The projected health workforce size by 2030 is 84 million health workers. This represents an average growth of 29% from 2020 to 2030 which is faster than the population growth rate (9.7%). This reassessment presents a revised global health workforce shortage of 15 million health workers in 2020 decreasing to 10 million health workers by 2030 (a 33% decrease globally). WHO African and Eastern Mediterranean regions’ shortages are projected to decrease by only 7% and 15%, respectively.ConclusionsThe latest NHWA data show progress in the increasing size of the health workforce globally as more jobs are and will continue to be created in the health economy. It however masks considerable inequities, particularly in WHO African and Eastern Mediterranean regions, and alarmingly among the 47 countries on the WHO Support and Safeguards List. Progress should be acknowledged with caution considering the immeasurable impact of COVID-19 pandemic on health workers globally.

Background:Interstitial lung disease (ILD) is the foremost contributor to mortality in systemic sclerosis (SSc). High-resolution computed tomography (HRCT) remains the gold standard for ILD diagnosis. While previously recommended for all patients at the time of SSc diagnosis, HRCT screening is now conditionally advised by the 2023 ACR guideline for managing ILD across rheumatic diseases, explicitly targeting patients at increased risk of developing ILD. The impact of not screening all SSc patients for ILD has so far not been assessed in detail.Objectives:To explore the impact of HRCT screening on ILD identification, ILD progression, and survival across two countries with differing screening approaches.Methods:This multicenter study involved 314 Romanian SSc (Ro-SSc) patients from “Sfanta Maria” Clinical Hospital in Bucharest (with non-universal HRCT-ILD screening) and 905 Norwegian SSc (Nor-SSc) patients from Oslo University Hospital (with routine HRCT screening since 2000). The study aimed to assess the prevalence of ILD and factors associated with HRCT conduction over three periods: 2000-2010, 2010-2020, and 2020-2023. Baseline and last available follow-up pulmonary function tests (PFTs) were retrieved. ILD progression was categorized based on forced vital capacity (FVC) decline as severe (>10% FVC decline) and moderate (5-10% FVC decline). We defined the presence of significant progression in the absence of HRCT as likely ILD. Logistic and Cox regression were conducted.Results:Baseline screening for ILD with HRCT was performed in 37% (117) Ro- and 96% (871) Nor-SSc patients. The use of HRCT increased in the Ro-SSc cohort over time, with 60% of all patients undergoing HRCT after 2020, while remaining stable in the Nor-SSc cohort. HRCT screening in the Nor-SSc cohort was not based on risk factors for ILD. In the Ro-SSc cohort, HRCT screening was significantly associated with SSc-ILD risk factors, including male sex, diffuse cutaneous SSc, anti-topoisomerase I positivity, presence of respiratory symptoms, and lower FVC (Figure 1). Among all patients who underwent HRCT, 95% (190) of Ro- and 45% (388) of Nor-SSc were diagnosed with ILD. At the time of ILD diagnosis, Ro-SSc patients showed longer disease duration (4.41±3.2 vs. 2.1±2.9 years, p<.001) and more severe ILD with lower FVC (74.4±17.4% vs 90.4±23.7, p<001), and a higher prevalence of ≥20% fibrosis on HRCT (40% vs 11%, p<.001), compared to the Nor-SSc cohort. To estimate the impact of only screening SSc patients with risk factors for ILD, we next assessed patients in the Ro-SSc cohort not screened for ILD by HRCT and compared them to patients screened with HRCT and Nor-SSc patients without HRCT. Among the 40% of Ro-SSc cases without HRCT, a significant number experienced FVC decline, while Nor-SSc patients without HRCT showed no decline (Figure 2). The likelihood of ILD in Ro-SSc patients without HRCT was confirmed through logistic regression [OR 1.95 (0.49-2.63), p<0.001)]. In total, 23% of Ro-SSc and 30% of Nor-SSc patients died. As expected, in both HRCT-assessed SSc cohorts, FVC decline was predictive for mortality (Ro-SSc: HR 4.32, 95%CI 0.21-6.58, p<.001; Nor-SSc: HR 2.05, 95% CI 0.42-10.0, p<.001). In Ro-SSc patients without HRCT, FVC decline was predictive for mortality in the same range (HR 4.72, 95 % CI 1.43-15.5, p=0.01).Conclusion:Our results suggest that upfront HRCT screening of all SSc patients allows for an earlier diagnosis of ILD. Selective HRCT referral practices based on known risk factors leave a significant number of progressive ILD cases undiagnosed, with missed opportunities for treatment. Overall, the current results suggest that referring all newly diagnosed SSc patients to primary ILD screening by HRCT is warranted.REFERENCES: NIL. Acknowledgements:NIL.Disclosure of Interests:Cristina Nita: None declared, Laura Maria Groșeanu: None declared, Daniela Opriș-Belinski: None declared, Mihaela Popescu: None declared, Athir Eddan: None declared, Emily Langball: None declared, Håvard Fretheim Boehringer Ingelheim, Bayer, Henriette Didriksen: None declared, Hilde Jenssen Bjørkekjær Jannsen, Phuong Phuong Diep: None declared, Torhild Garen: None declared, Mike Durheim: None declared, Øyvind Midtvedt: None declared, Trond M Aaløkken: None declared, Oliver Distler Boehringer Ingelheim, Janssen, Medscape, CITUS AG, 4P-Pharma, Abbvie, Acceleron, Alcimed, Altavant, Amgen, AnaMar, Argenx, Arxx, AstraZeneca, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galderma, Galapagos, Glenmark, Gossamer, Horizon, Janssen, Kymera, Lupin, Medscape, Merck, Miltenyi Biotec, Mitsubishi Tanabe, Novartis, Orion, Prometheus, Redxpharma, Roivant, Topadur and UCB, Øyvind Molberg: None declared, Andra Bălănescu: None declared, Anna-Maria Hoffmann-Vold Boehringer Ingelheim, Boehringer Ingelheim, Janssen, Medscape, Merck Sharp & Dohme, Novartis and Roche, ARXX, BMS, Boehringer Ingelheim, Genentech, Janssen, Medscape, Merck Sharp & Dohme and Roche, Boehringer Ingelheim, Janssen.

Background:Rheumatoid arthritis (RA) is a chronic autoimmune disease caused by genetic and environmental factors characterized by joint inflammation. The JAK-STAT inhibitors (jakinibs) are among the therapeutic options together with conventional and biological Disease Modifying Antirheumatic Drugs (DMARDs) [1].Objectives:To determine the impact of jakinibs in monocyte and Natural Killer cells (NK) subsets in RA patients by flow cytometry.Methods:A total of 51 patients treated with jakinibs were recruited, 20 healthy donors and 20 RA patients treated with biological DMARDs, both paired by sex and age with the jakinibs group, were enrolled as controls. Peripheral blood mononuclear cells (PBMCs) were isolated by density gradient using Ficoll. Multiparametric flow cytometry was performed for immunophenotype characterization of different subsets of NK cells acquired in DX Flex cytometer (Beckman Coulter).Results:Within the jakinib group, 22 (43.14%) patients were treated with baricitinib (Bari), (27.45%) 14 with tofacitinib (Tofa), 11 (21.57%) with filgotinib (Filgo) and 4 (7.84%) with upadacitinib (Upa); whereas in the RA control group: 11 patients were treated with tocilizumab and 9 treated with abatacept. A significant decrease in the percentage of cytotoxic NK Dim (CD56+CD16+) subset was observed in the jakinib group in comparison to the RA control group (92.18 (89.18-96.59) vs 87.28 (81.29-90.93) p=0.001). There were significant differences between jakinib group and both healthy and RA control groups in the percentage of activated NK Dim expressing Nkp30 (59.51 (32.19-80.34), 89.74 (84.81-95.81) and 85.28 (67.08-93.16), respectively; p values: <0.0001 and 0.007). In addition, the percentage of intermediate monocytes (CD14+, CD16+) was decreased in jakinib group in comparison with RA and healthy controls (9.84 (5.12-16.36), 19.41 (14.39-30.30) and 20.55 (15.34-30.09), respectively; p values: 0.001 and <0.0001).Conclusion:The JAK-STAT inhibition by jakinibs affects innate cells in a different way than biological DMARDs do. The decrease in both the cytotoxic activated NK subset and intermediate monocytes could explain some of the side effects caused by these drugs related to intracellular threats such as viral infections or possible neoplasia appearances. Further functional studies should be addressed to better understand the impact of jakinibs in innate cell subsets and their relationship with adverse effects in RA patients.REFERENCES:[1] Meudec L, Richebé P, Pascaud J, Mariette X, Nocturne G. Janus kinase inhibitors alter NK cell phenotypes and inhibit their antitumour capacity. Rheumatology (Oxford). 2023 Aug 1;62(8):2855-2863. DOI: 10.1093/rheumatology/keac710. PMID: 36583542.Figure 1.Dotplots depicting the percentage of NK Dim cells (a), NK Dim Nkp30 cells (b) and Intermediate Monocytes (c) in the three groups studied (healthy controls in green dots, RA controls in grey squares and jakinib patients in beige rhombuses).The whiskers represent the median, first and third quartile. P values are represented as follows: * P <.05, ** P <.01, ***P <.001, ***P<.0001. NS: not significant differences found.Acknowledgements:NIL.Disclosure of Interests:Juan José Fernández Cabero: None declared, Carmen Lasa-Teja: None declared, Alejandra Comins-Boo: None declared, David San Segundo: None declared, Marcos López Hoyos: None declared, Ricardo Blanco Pfizer, Roche, Bristol-Myers, Lilly, Galapagos, Novartis, Janssen, GSK, and MSD.

Background: The CD4 cell count of patients during diagnosis and distribution of CD4 cell counts in the patient population are important to understand infection-diagnosis interval and incidence rate of human immunodeficiency virus (HIV) infection, respectively. However, this information has not been published in Japan. This study aimed to describe the change in CD4 cell count trend and clarify the change in patients’ characteristics in association with the CD4 cell count information.Methods: A descriptive study was conducted to analyze the medical records of patients with HIV who visited one of the largest acquired immunodeficiency syndrome (AIDS) core hospitals in western Japan. The basic characteristics, CD4 cell counts, viral load, and diagnosis-treatment interval between the first (2003–2010) and second (2011–2017) halves of the study duration were compared.Results: The distribution of the CD4 cell counts significantly changed between 2003–2010 and 2011–2017 (χ2 = 20.42, p < 0.001). The proportion of CD4 cell count <200 cells/mm3 increased (38.8% in 2003 to 45.9% in 2017), whereas CD4 cell count ≥500 cells/mm3 decreased (19.4% in 2003 to 12.2% in 2017). Moreover, the distributions of age groups, history of HIV screening test, patient outcomes, HIV viral load, and diagnosis-treatment interval also significantly changed (χ2 = 25.55, p < 0.001; χ2 = 8.37, p = 0.015; χ2 = 6.07, p = 0.014; χ2 = 13.36, p = 0.020; χ2 = 173.76, p < 0.001, respectively).Conclusion: This study demonstrated the fundamental trends of the HIV epidemic in Osaka, Japan, and indicated the incidence rate of HIV was decreasing in Japan.