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Purpose (stating the main purposes and research question)Vibrio cholerae is classified in O-antigen polysaccharide outer membrane properties where O1 and O139 are strains that cause pandemics and epidemics while non-O1/non-O139 usually cause mild disease. The dynamic evolution of Vibrio cholerae involves new virulence factors through horizontal gene transfer and formerly nontoxigenic serogroups are being reported as causing increasingly severe forms of human disease. Our purpose was to investigate serogroup and virulence factors in one imported isolate from Vietnam and compare these to virulence factors seen in different strains of Vibrio cholerae.MethodsWe have serotyped one isolate of imported Vibrio cholerae from Vietnam to Denmark and performed whole genome sequencing to identify known virulence genes. ResultsWe have identified virulence factors in our isolate that are recently discovered and one toxin, MakA, has not previously been reported from an Asian strain. The isolate was found to be a serogroup non-O1/non-O139 strain, however, sequence analysis gave a 96, 6% ID match of the wbfZ gene, stipulating our isolate to belong to either serogroup O22 or O139. ConclusionsLooking at the combination of virulence factors of the isolate we suggest the finding of a rough variant of a nontoxigenic Vibrio cholerae O139 rather than a O22 serogroup version. This is a rare finding in a clinical isolate.

OBJECTIVES: The long-term side effects of stavudine (d4T) led to recommendations in 2009 to phase out use of this drug. We aimed to describe temporal patterns of d4T use across Europe. METHODS: Patients taking combination antiretroviral therapy (cART) in EuroSIDA with follow-up after 1 January 2006 were included in the study. cART was defined as d4T-containing [d4T plus at least two other antiretrovirals (ARVs) from any class] or non-d4T-containing (at least three ARVs from any class, excluding d4T). Poisson regression was used to describe temporal changes in the prevalence of d4T use and factors associated with initiating d4T. RESULTS: A total of 5850 patients receiving cART on 1 January 2006 were included in the current analysis, rising to 7768 patients on January 1 2013. During this time, the prevalence of d4T use fell from 11.2% to 0.7%, with an overall decline of 19% per 6 months [95% confidence interval (CI) 19-20%]. d4T use declined fastest in Northern Europe [26% (95% CI 23-29%) per 6 months], and slowest in Eastern Europe [17% (95% CI 16-19%) per 6 months]. In multivariable Poisson regression models, new d4T initiations decreased by 14% per 6 months [adjusted incidence rate ratio (aIRR) 0.86; 95% CI 0.80-0.91]. Factors associated with initiating d4T were residence in Eastern Europe (aIRR 4.31; 95% CI 2.17-9.98) versus other European regions and HIV RNA > 400 copies/mL (aIRR 3.11; 95% CI 1.60-6.02) versus HIV RNA < 400 copies/mL. CONCLUSIONS: d4T use has declined sharply since 2006 to low levels in most regions; however, a low but persistent level of d4T use remains in Eastern Europe, where new d4T initiations post 2006 are also more common. The reasons for the regional differences may be multifactorial, but it is important to ensure that all clinicians treating HIV-positive patients are aware of the potential harmful effects associated with d4T.