Alternative splicing of the amelogenin gene generates a family of proteins secreted by ameloblasts that are primarily responsible for tooth enamel formation. Here the presence of two additional exons, downstream of exon 7, which are followed by an alternate polyadenylation site, is reported. Long polymerase chain reaction was used with a rat genomic amelogenin template to amplify sequences downstream from the primary polyadenylation site. Within the amplified sequences, two exons of 45 bp (exon 8) and 110 bp (exon 9) were identified. The presence of these additional exons in the human and mouse genome was indicated by Southern blot analysis. Antibodies raised against a synthetic peptide corresponding to a sequence encoded by exon 9 positively stained ameloblasts in sections of developing murine and porcine unerupted teeth. These results suggest that an amelogenin protein(s) that includes sequences derived from exons 8 and 9 is synthesized by the ameloblasts.

Background

Little is known about the influence of ongoing barriers to care in the persistence of hepatitis C virus (HCV) viremia after treatment with direct-acting antivirals (DAAs) among people living with human immunodeficiency virus (PLWH).

Methods

We conducted a retrospective cohort analysis of PLWH treated through the standard of care in 3 Western countries, to investigate the predictors of HCV treatment failure (clinical or virologic), defined as having a detectable serum HCV ribonucleic acid within 12 weeks after DAA discontinuation. In addition to HCV and liver-related predictors, we collected data on ongoing illicit drug use, alcohol abuse, mental illness, and unstable housing. Logistic regression analyses were used to identify predictors of HCV treatment failure.

Results

Between January 2014 and December 2017, 784 PLWH were treated with DAA, 7% (n = 55) of whom failed HCV therapy: 50.9% (n = 28) had a clinical failure (discontinued DAA therapy prematurely, died, or were lost to follow-up), 47.3% (n = 26) had an HCV virologic failure, and 1 (1.8%) was reinfected with HCV. Ongoing drug use (odds ratio [OR] = 2.60) and mental illness (OR = 2.85) were independent predictors of any HCV treatment failure. Having both present explained 20% of the risk of any HCV treatment failure due to their interaction (OR = 7.47; P < .0001). Predictors of HCV virologic failure were ongoing illicit drug use (OR = 2.75) and advanced liver fibrosis (OR = 2.29).

Conclusions

People living with human immunodeficiency virus with ongoing illicit drug use, mental illness, and advanced liver fibrosis might benefit from enhanced DAA treatment strategies to reduce the risk of HCV treatment failure.