NOTE: Lserv posted at www.RobertMalow.org where you can use the search box to find current and prior Lserv content. Any questions concerning the Lserv (e.g. content that may be valuable to post, literature queries) should be directed to my graduate assistant, Jennifer Attonito at firstname.lastname@example.org. To subscribe or unsubscribe to this HIV Lserv, go to: http://listserv.fiu.edu/archives/hiv.html. Click “Join or Leave HIV.” Enter ‘Name’ and ‘Email Address’ (do not change any of the other settings on this page) then click ‘Join HIV’ button or the “Leave HIV (unsubscribe).
63. Extended follow-up confirms early vaccine-enhanced risk of HIV acquisition and demonstrates waning effect over time among participants in a randomized trial of recombinant adenovirus HIV vaccine (Step study).
Prev Chronic Dis. 2012 May;9:E93. Epub 2012 May 3.
Integration of HIV and Noncommunicable Diseases in Health Care Delivery in Low- and Middle-Income Countries.
Monash University, 99 Commercial Rd, VIC 3004, Melbourne, Australia. E-mail: email@example.com
HIV infection, a communicable disease, and noncommunicable diseases (NCDs) are among the major health concerns worldwide. An estimated 33 million people live with HIV, two-thirds of them in sub-Saharan Africa, where three-fourths of all AIDS-related deaths occur (1). Illness and death from NCDs exceed these numbers. In 2008, the last year for which figures are available, 36 million deaths were attributed to NCDs (2). In that same year, approximately 12.7 million people worldwide were living with cancer (2), and in 2011 approximately 366 million people worldwide were living with diabetes (3). The NCD burden is greatest in low- and middle-income countries, which account for an estimated 80% of all NCD-related deaths; about one-third of these deaths occur before age 60 years (4).
Until recently, diseases were considered either communicable (infectious) or chronic. As a result of advances in treatment, HIV infection now challenges that model so that the definition of chronic disease is not as simple or clear-cut as it once was. The World Health Organization describes chronic disease as a disease of long duration and slow progression (5). HIV and NCDs, a medical condition or diseases that are noninfectious, are now the major chronic diseases of public health concern, especially in low- and middle-income countries. Integrated approaches to address HIV infection and NCDs as well as other chronic diseases in these countries need to be developed.
Different chronic diseases have different clinical interrelationships. For example, people with HIV infection are at increased risk of other chronic infectious diseases such as tuberculosis and NCDs such as cancer, diabetes, and cardiovascular diseases (6). Antiretroviral treatments of HIV infection increase the risk of hyperlipidemia and diabetes. People living with HIV infection have 3 sources of risk of contracting NCDs: first, from HIV infection itself; second, from antiretroviral treatments; and third, from the risk associated with increasing age (7).
Chronic diseases share similarities in their risk factors, progression, and management. Unsafe sexual behavior is the major risk factor for HIV infection, and lifestyle factors such as unhealthy diet, insufficient physical activity, tobacco use, and alcohol abuse are the major risk factors for NCDs. Strategies for preventing HIV infection and NCDs are directed at modifying these behaviors and lifestyles. Effects of both HIV infection and NCDs develop progressively over time. As with management of NCDs, management of HIV infection focuses on positive health behaviors. The essential elements of prevention and management of HIV infection and NCDs — community and family support, patient involvement, and continuous follow up — are similar despite differences in the origin, pathogenesis, and clinical features of the diseases.
J Am Geriatr Soc. 2012 May 9. doi: 10.1111/j.1532-5415.2012.03948.x. [Epub ahead of print]
Summary Report from the Human Immunodeficiency Virus and Aging Consensus Project: Treatment Strategies for Clinicians Managing Older Individuals with the Human Immunodeficiency Virus.
[No authors listed]
By 2015, most of the people living with the human immunodeficiency virus (HIV) in the United States will be aged 50 and older. Many will have known their HIV status for at least a decade, and most will have received antiretroviral therapy for some, if not all, of the time since testing positive. As these individuals advance in years, they frequently acquire diseases more commonly associated with aging than with HIV. This represents a unique challenge for today’s medical providers. Although these individuals may appear considerably older than their chronological age, they are typically too young to see a geriatrician. An HIV specialist, although knowledgeable in the nuances of antiretroviral therapy, may be less comfortable managing multiple age-related illnesses. Similarly, a geriatrician experienced in managing multiple, age-related conditions may be less familiar with adjusting HIV-related therapies. In this era of caring for older adults with HIV, these two medical disciplines are finding they have much to learn from each other.
Open AIDS J. 2012;6:29-35. Epub 2012 Apr 26.
Cardiovascular Disease in Blacks with HIV/AIDS in the United States: A Systematic Review of the Literature.
Oramasionwu CU, Hunter JM, Brown CM, Morse GD, Lawson KA, Koeller JM, Frei CR.
University of North Carolina, UNC Eshelman School of Pharmacy, Chapel Hill, NC,
OBJECTIVES: Blacks in the United States bear a disproportionate burden of Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) and cardiovascular disease (CVD). It has been demonstrated that HIV/AIDS itself and HIV/AIDS-related therapies may predispose patients to early onset of CVD. It is also possible that Black patients may be at greater risk for this interaction. Thus, the objective of this literature review was to identify and critically evaluate disparities in CVD between Black and White patients with HIV/AIDS.
DESIGN: A MEDLINE search (January 1, 1950 to May 31, 2010) was performed to identify original research articles published in the English language. The search was limited to articles that evaluated race-based disparities for CVD among patients with HIV/AIDS.
RESULTS: Of the five publications included in this review, a CVD diagnosis was the primary focus for only three of the studies and was a secondary objective for the remaining two studies. Two studies concluded that Blacks were more likely than Whites to have a CVD diagnosis at time of hospital admission, whereas, the other three studies did not detect any race-based disparities.
CONCLUSIONS: Few studies have addressed the issue of Black race, HIV/AIDS, and CVD, highlighting the need for future research in this area.
Am J Trop Med Hyg. 2012 May;86(5):902-7.
A controlled study of funding for human immunodeficiency virus/acquired immunodeficiency syndrome as resource capacity building in the health system in rwanda.
Shepard DS, Zeng W, Amico P, Rwiyereka AK, Avila-Figueroa C.
Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, Massachusetts; Abt Associates, Bethesda, Maryland.
Because human inmmunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) receives more donor funding globally than that for all other diseases combined, some critics allege this support undermines general health care. This empirical study evaluates the impact of HIV/AIDS funding on the primary health care system in Rwanda. Using a quasi-experimental design, we randomly selected 25 rural health centers (HCs) that started comprehensive HIV/AIDS services from 2002 through 2006 as the intervention group. Matched HCs with no HIV/AIDS services formed the control group. The analysis compared growth in inputs and services between intervention and control HCs with a difference-in-difference analysis in a random-effects model. Intervention HCs performed better than control HCs in most services (seven of nine), although only one of these improvements (Bacille Calmette-Guérin vaccination) reached or approached statistical significance. In conclusion, this six-year controlled study found no adverse effects of the expansion of HIV/AIDS services on non-HIV services among rural health centers in Rwanda.
PLoS One. 2012;7(4):e35268. Epub 2012 Apr 27.
Integrating Prevention of Mother-to-Child HIV Transmission Programs to Improve Uptake: A Systematic Review.
Tudor Car L, Van Velthoven MH, Brusamento S, Elmoniry H, Car J, Majeed A, Tugwell P, Welch V, Marusic A, Atun R.
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.
BACKGROUND: We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries.
METHODS: We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources.
RESULTS: Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04-1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001).
CONCLUSION: Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs.
HIV AIDS (Auckl). 2012;4:45-50. Epub 2012 Apr 12.
Considerations in using text messages to improve adherence to highly active antiretroviral therapy: a qualitative study among clients in Yaoundé, Cameroon.
Mbuagbaw L, Bonono-Momnougui RC, Thabane L.
Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon.
Poor adherence to highly active antiretroviral therapy (HAART) is a major hindrance to the reduction of mortality and morbidity due to HIV. This qualitative study used focus groups to explore the views and experiences of HIV patients on HAART with adherence reminders, especially the text message (SMS [short message service]). The ethnographic data obtained were used to design a clinical trial to assess the effect of motivational text messages versus usual care to enhance adherence to HAART among HIV patients in Yaoundé, Cameroon. Participants appreciated the idea of a timely SMS reminder, and cited the physician as a role model. They expressed concerns about privacy. Long-term life goals were a motivating factor to adhere. Overall, text messaging was viewed positively as a tool with a dual function of reminder and motivator. Messages coming from the attending physician may have a stronger impact. Trials investigating the use of text messages to improve adherence to HAART need to consider the content and timing of SMS, taking into account technical challenges and privacy.
PLoS One. 2012;7(5):e36186. Epub 2012 May 2.
Young HIV-Infected Children and Their Adult Caregivers Prefer Tablets to Syrup Antiretroviral Medications in Africa.
Nahirya-Ntege P, Cook A, Vhembo T, Opilo W, Namuddu R, Katuramu R, Tezikyabbiri J, Naidoo-James B, Gibb D; on behalf of the ARROW Trial Team.
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0036186
BACKGROUND: Provision of anti-retroviral therapy (ART) for HIV-infected children is complicated using syrup formulations, which are costlier than tablets, harder to transport and store and difficult for health-workers to prescribe and caregivers to administer. Dispersible/crushable tablets may be more appropriate. We studied the acceptability of syrups and scored tablets among young children who used both in the AntiRetroviral Research fOr Watoto (ARROW) trial.
METHODS: ARROW is an ongoing randomized trial of paediatric ART monitoring and treatment strategies in 1206 children in Uganda and Zimbabwe. 405 children initially received syrups of combination ART including Nevirapine, Zidovudine, Abacavir and Lamivudine before changing, when reaching the 12-<15 kg weightband, to scored adult-dose tablets prescribed according to WHO weightband tables. Caregiver expectations and experiences were collected in questionnaires at their last visit on syrups and after 8 and 24 weeks on tablets.
RESULTS: Questionnaires were completed by caregivers of 267 children (median age 2.9 years (IQR 2.5, 3.4)). At last visit on syrups, 79% caregivers reported problems with syrups, mostly related to number, weight, transportation and conspicuousness of bottles. Difficulties taking tablets were expected by 127(48%) caregivers; however, after 8 and 24 weeks, only 26% and 18% reported their children had problems with tablets and no problems were reported with transportation/conspicuousness. Taste, swallowing or vomiting were reported as problems ‘sometimes/often’ for 14%, 9%, 22% children on syrups and 16%, 9%, 8% on tablets. At last visit on syrups, 74% caregivers expected to prefer tablets but only 27% thought their child would. After 8/24 weeks, 94%/97% caregivers preferred tablets and 57%/59% reported their child did.
CONCLUSIONS: Most children at about 3 years can take tablets; caregivers and children themselves generally prefer tablets to liquid formulations of HIV medications above this age. Preferences of caregivers and children should be considered when designing and licensing paediatric drug formulations.
PLoS One. 2012;7(5):e35547. Epub 2012 May 1.
Wasti SP, Simkhada P, Randall J, Freeman JV, van Teijlingen E.
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0035547
BACKGROUND: Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal.
METHODS: A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts.
RESULTS: A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR=17.99, p=0.014); alcohol use (OR=12.89, p=<0.001), being female (OR=6.91, p=0.001), being illiterate (OR=4.58, p=0.015), side-effects (OR=6.04, p=0.025), ART started ≤24 months (OR=3.18, p=0.009), travel time to hospital >1 hour (OR=2.84, p=0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence.
CONCLUSION: Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients’ lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients.
PLoS One. 2012;7(4):e35401. Epub 2012 Apr 26.
Tilghman MW, May S, Pérez-Santiago J, Ignacio CC, Little SJ, Richman DD, Smith DM.
Department of Medicine, University of California San Diego, La Jolla, California.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0035401
BACKGROUND: To develop a low cost method to screen for virologic failure of antiretroviral therapy (ART) and HIV-1 drug resistance, we performed a retrospective evaluation of a screening assay using serial dilutions of HIV-1 RNA-spiked blood plasma and samples from patients receiving >6 months of first-line ART.
METHODS: Serial dilution testing was used to assess sensitivity of a simple PCR-based assay (targeted at ≥1,000 HIV RNA copies/mL). We created blood plasma minipools of five samples, extracted HIV RNA from the pools, PCR amplified the reverse transcriptase (RT) coding region of the HIV-1 pol gene from extracted RNA, sequenced PCR product of positive pools, and used sequences to determine drug resistance. Sensitivity, specificity, and predictive values were determined for different levels of virologic failure based on maximum viral loads of individual samples within a pool.
RESULTS: Of 295 samples analyzed, 43 (15%) had virologic failure at ≥50 copies/mL (range 50-10,500 copies/mL, four at ≥1,000 copies/mL). The assay demonstrated 100% sensitivity to detect virus from these four samples, requiring only one round of PCR, and 56% and 89% sensitivity to detect samples with ≥50 and ≥500 copies/mL using two rounds. Amplified PCR products of all positive pools were successfully sequenced and 30% harbored ≥1 major resistance mutation. This method would have cost 10% of the combined costs of individual viral load and resistance testing.
CONCLUSIONS: We present a novel method that can screen for both virologic failure of first-line ART and drug resistance. The method is much less expensive than current methods, which may offer sustainability in resource-limited settings.
J Acquir Immune Defic Syndr. 2012 Apr 1;59(4):e52-9.
Socioeconomic support reduces nonretention in a comprehensive, community-based antiretroviral therapy program in Uganda.
Talisuna-Alamo S, Colebunders R, Ouma J, Sunday P, Ekoru K, Laga M, Wagner G, Wabwire-Mangen F.
Medical Department, Reach Out Mbuya HIV/AIDS Initiative, Kampala, Uganda. firstname.lastname@example.org
OBJECTIVES: We evaluated the benefit of socioeconomic support (S-E support), comprising various financial and nonfinancial services that are available based on assessment of need, in reducing mortality and lost to follow-up (LTFU) at Reach Out Mbuya, a community-based, antiretroviral therapy program in Uganda.
DESIGN: Retrospective observational cohort data from adult patients enrolled between May 31, 2001, and May 31, 2010, were examined.
METHODS: Patients were categorized into none, 1, and 2 or more S-E support based on the number of different S-E support services they received. Using Cox proportional hazards regression, we modeled the association between S-E support and mortality or LTFU. Kaplan-Meier curves were fitted to examine retention functions stratified by S-E support.
RESULTS: In total, 6654 patients were evaluated. After 10 years, 2700 (41%) were retained. Of the 3954 not retained, 2933 (74%) were LTFU and 1021 (26%) had died. After 1, 2, 5, and 10 years, the risks of LTFU or mortality in patients who received no S-E support were significantly higher than those who received some S-E support. In adjusted hazards ratios, patients who received no S-E support were 1.5-fold (1.39-1.64) and 6.7-fold (5.56-7.69) more likely to get LTFU compared with those who received 1 or ≥ 2 S-E support, respectively. Likewise, patients who received no S-E support were 1.5-fold (confidence interval: 1.16 to 1.89) and 4.3-fold (confidence interval: 2.94 to 6.25) more likely to die compared with those who received 1 or 2+ S-E support, respectively.
CONCLUSIONS: Provision of S-E support reduced LTFU and mortality, suggesting the value of incorporating such strategies for promoting continuity of care.
PLoS One. 2011;6(11):e27763. Epub 2011 Nov 17.
Antiretroviral treatment cohort analysis using time-updated CD4 counts: assessment of bias with different analytic methods.
Kranzer K, Lewis JJ, White RG, Glynn JR, Lawn SD, Middelkoop K, Bekker LG, Wood R.
Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. email@example.com
BACKGROUND: Survival analysis using time-updated CD4+ counts during antiretroviral therapy is frequently employed to determine risk of clinical events. The time-point when the CD4+ count is assumed to change potentially biases effect estimates but methods used to estimate this are infrequently reported.
METHODS: This study examined the effect of three different estimation methods: assuming i) a constant CD4+ count from date of measurement until the date of next measurement, ii) a constant CD4+ count from the midpoint of the preceding interval until the midpoint of the subsequent interval and iii) a linear interpolation between consecutive CD4+ measurements to provide additional midpoint measurements. Person-time, tuberculosis rates and hazard ratios by CD4+ stratum were compared using all available CD4+ counts (measurement frequency 1-3 months) and 6 monthly measurements from a clinical cohort. Simulated data were used to compare the extent of bias introduced by these methods.
RESULTS: The midpoint method gave the closest fit to person-time spent with low CD4+ counts and for hazard ratios for outcomes both in the clinical dataset and the simulated data.
CONCLUSION: The midpoint method presents a simple option to reduce bias in time-updated CD4+ analysis, particularly at low CD4 cell counts and rapidly increasing counts after ART initiation.
AIDS Res Hum Retroviruses. 2012 May 8. [Epub ahead of print]
HIV-1 Virological Response and Prevalence of HIV-1 Drug Resistance among Patients Receiving Antiretroviral Therapy, Shandong, China.
Zhang J, Kang D, Lin B, Sun X, Fu J, Bi Z, Nkengasong JN, Yang C.
CDC, International Laboratory Branch, Atlanta, Georgia, FWZ9@cdc.gov.
Shandong province has been providing antiretroviral therapy (ART) to eligible HIV/AIDS patients since 2003 using first-line regimens. We conducted a cross-sectional study to assess virological response and resistance development from ART-patients. Between 2006 and 2008, blood was collected from 143 ART-patients. Viral load (VL) was determined with a detection limit of 50 copies/ml; those with detectable VL were genotyped with dried plasma spots using a broadly sensitive genotyping assay. Resistance mutations were identified using the Stanford HIV drug resistance database. Of the 143 patients, 72% (95% confidence interval (CI): 65.9-78.2) suppressed their VL to <50 copies/ml. Genotyping analysis of the remaining 40 patients revealed that 21 (53%, CI: 37.0-68.0) harbored ≥ 1 mutations. The most common mutations were thymidine-analog mutations (22.5%) and M184V (10%) to nucleoside reverse transcriptase inhibitor (NRTI), and V106I/A /M (17.5%), Y181C (15%) and H221Y (12.5%) to Non-NRTI (NNRTI); 13 patients had mutations to both NRTI and NNRTI. Patients with VL >1,000 copies/ml appear to harbor more mutations than those with VL between 50 and 1000 (62.1% vs 27.3%, p>0.05). Resistance mutations were intensified among 10 patients for whom two sequential specimens were obtained and accumulation of resistance mutations predicted compromised treatment outcomes and future drug selections. This study provides a snapshot of virological response and resistance profile for patients on first-line regimens, indicating patient monitoring is a critical component in preventing the accumulations of resistance mutations among patients failing their regimens and thus maintain the effectiveness of the first-line regimens.
B Mann, M-J Milloy, T Kerr, R Zhang, J Montaner and E Wood
HIV Medicine Article first published online: 2 MAY 2012
Adherence to antiretroviral therapy (ART) among injecting drug users (IDUs) is often suboptimal, yet little is known about changes in patterns of adherence since the advent of highly active antiretroviral therapy in 1996. We sought to assess levels of optimal adherence to ART among IDUs in a setting of free and universal HIV care.
Data were collected through a prospective cohort study of HIV-positive IDUs in Vancouver, British Columbia. We calculated the proportion of individuals achieving at least 95% adherence in the year following initiation of ART from 1996 to 2009.
Among 682 individuals who initiated ART, the median age was 37 years (interquartile range 31–44 years) and 248 participants (36.4%) were female. The proportion achieving at least 95% adherence increased over time, from 19.3% in 1996 to 65.9% in 2009 (Cochrane–Armitage test for trend: P < 0.001). In a logistic regression model examining factors associated with 95% adherence, initiation year was statistically significant (odds ratio 1.08; 95% confidence interval 1.03–1.13; P < 0.001 per year after 1996) after adjustment for a range of drug use variables and other potential confounders.
The proportion of IDUs achieving at least 95% adherence during the first year of ART has consistently increased over a 13-year period. Although improved tolerability and convenience of modern ART regimens probably explain these positive trends, by the end of the study period a substantial proportion of IDUs still had suboptimal adherence, demonstrating the need for additional adherence support strategies.
AIDS. 2012 May 2. [Epub ahead of print]
Assessing the effectiveness of antiretroviral regimens in cohort studies involving HIV-positive injection drug users.
Lima VD, Nosyk B, Wood E, Kozai T, Zhang W, Chan K, Montaner JS.
St. Paul’s Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada.
OBJECTIVE: We compared the effectiveness of different HAART regimens considering, separately, history of injection drug use (IDU) (yes/no). DESIGN,
METHODS: A total of 1163 HIV-infected patients initiated HAART between January 1, 2000 and February 28, 2009 in British Columbia, Canada, and were followed until February 28, 2010. HAART effectiveness was measured by the ability to achieve viral suppression < 50 copies/mL at 6 months. We compared HAART regimens containing efavirenz and boosted atazanavir. We developed logistic regression models using different techniques to control for potential confounders.
RESULTS: Among the 1163 patients, 796 (68%) achieved viral suppression at 6 months (32% reporting a history of IDU). Different confounding models yielded very similar odds ratios for achieving viral suppression. Boosted atazanavir-based HAART demonstrated to be the most effective regimen, showing a surprisingly higher benefit for patients with a history of IDU (odds ratios from different models ranged from 1.74-1.95 versus 1.45-1.51).
CONCLUSIONS: The literature has conflicting results regarding the effectiveness of highly active antiretroviral treatment (HAART) to treat HIV infection among those with a history of injection drug use (IDU). We have shown that most patients, with and without a history of IDU, were able to achieve viral suppression at 6 months. Boosted atazanavir-based HAART was the most resilient regimen and it was more effective than efavirenz-based HAART among IDU. Given the limited inclusion of IDU in clinical trials of HAART’s efficacy, a randomized clinical trial comparing different first-line HAART regimens among IDU is warranted based on these results.
AIDS Behav. 2012 May 8. [Epub ahead of print]
Hutton HE, McCaul ME, Chander G, Jenckes MW, Nollen C, Sharp VL, Erbelding EJ.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/5547552wnjp22833/
Effective sexual risk reduction strategies for HIV-infected individuals require an understanding of alcohol’s influence on specific sexual behaviors. We conducted audio-computer-assisted-self-interviews on 910 patients from two HIV primary care programs. The association between alcohol use and risky sexual behaviors was examined using multivariable logistic regression adjusting for age, education, race/ethnicity and drug use. Frequent/binge drinking was associated with engaging in anal sex and having multiple sex partners among women, engaging in insertive anal sex among gay/bisexual men, and was unrelated to risky sexual behaviors among heterosexual men. Infrequent drinkers did not differ in sexual risk behaviors from abstainers among women or men. Finally, there was no interaction effect between race/ethnicity and alcohol use on the association with sexual risk behaviors. The study has yielded important new findings in several key areas with high relevance to HIV care. Results underscore the importance of routinely screening for alcohol use and risky sexual behaviors in HIV primary care.
Womens Health Issues. 2012 Jan;22(1):e1-7.
Stein MD, Caviness CM, Anderson BJ.
Butler Hospital, Providence, RI. Michael_Stein@brown.edu
INTRODUCTION AND BACKGROUND: At the time of incarceration, women have a high prevalence of sexually transmitted infections (STI). In the months after community release, women remain at high risk for new infections. This study assessed the rates and predictors of incident chlamydia, gonorrhea, and trichomoniasis in a sample of hazardously drinking women after incarceration.
METHODS: Self-reported behavioral data were collected from 245 incarcerated women. Vaginal swabs were collected at baseline, and 3- and 6-month time points and tested for chlamydia, gonorrhea, and trichomoniasis. Treatment was provided for all positive tests.
RESULTS: Participants’ mean age was 34.1 years of age; 175 (71.4%) were Caucasian, 47 (19.2%) were African American, 17 (6.9%) were Hispanic, and 6 (2.4%) were of other ethnic origins. The STI incidence rate was estimated to be 30.5 (95% confidence interval, 21.3-43.5) new infections per 100 person-years. Number of male sex partners reported during follow-up was a significant (z = 2.16; p = .03) predictor of STI; each additional male sex partner increased the estimated hazard of STI by 1.26.
CONCLUSION: Incarcerated women who are hazardous drinkers are at high risk for STI in the months after their return to the community. In addition to testing and treatment during incarceration, post-release rescreening, education, partner treatment, and follow-up are recommended.
Am J Public Health. 2012 May;102(5):867-76.
Longitudinal associations between adolescent alcohol use and adulthood sexual risk behavior and sexually transmitted infection in the United States: assessment of differences by race.
Khan MR, Berger AT, Wells BE, Cleland CM.
School of Public Health, University of Maryland, College Park; Child Trends, Washington, DC; Center for HIV Educational Studies and Training (CHEST), Hunter College, New York, NY. NYU College of Nursing, NY.
Objectives. We examined race differences in the longitudinal associations between adolescent alcohol use and adulthood sexually transmitted infection (STI) risk in the United States.
Methods. We estimated multivariable logistic regression models using Waves I (1994-1995: adolescence) and III (2001-2002: young adulthood) of the National Longitudinal Study of Adolescent Health (n = 10 783) to estimate associations and assess differences between Whites and African Americans.
Results. In adjusted analyses, adolescent alcohol indicators predicted adulthood inconsistent condom use for both races but were significantly stronger, more consistent predictors of elevated partnership levels for African Americans than Whites. Among African Americans but not Whites, self-reported STI was predicted by adolescent report of any prior use (adjusted odds ratio [AOR] = 1.47; 95% confidence interval [CI] = 1.00, 2.17) and past-year history of getting drunk (AOR = 1.53; 95% CI = 1.01, 2.32). Among Whites but not African Americans, biologically confirmed STI was predicted by adolescent report of past-year history of getting drunk (AOR = 1.68; 95% CI = 1.07, 2.63) and consistent drinking (AOR = 1.65; 95% CI = 1.03, 2.65).
Conclusions. African American and White adolescent drinkers are priority populations for STI prevention. Prevention of adolescent alcohol use may contribute to reductions in adulthood STI risk.
Drug Alcohol Depend. 2012 May 2. [Epub ahead of print]
Weber E, Blackstone K, Iudicello JE, Morgan EE, Grant I, Moore DJ, Woods SP; The Translational Methamphetamine AIDS Research Center (TMARC) Group.
Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA.
BACKGROUND: Unemployment rates are high among chronic methamphetamine (MA) users and carry a significant economic burden, yet little is known about the neurocognitive and psychiatric predictors of employment in this vulnerable population.
METHODS: The present study examined this issue in 63 participants with recent MA dependence and 47 comparison subjects without histories of MA use disorders. All participants completed a comprehensive neurocognitive, psychiatric and neuromedical evaluation. Individuals with HIV infection, severe neuropsychological or psychiatric conditions that might affect cognition (e.g., seizure disorder, schizophrenia), or a positive Breathalyzer or urine toxicology screen on the day of testing were excluded.
RESULTS: Consistent with previous research, a logistic regression revealed MA dependence as a significant, independent predictor of full-time unemployment status. Within the MA-dependent sample, greater impairment in global neurocognitive functioning and history of injection drug use emerged as significant independent predictors of unemployment status. The association between worse global cognitive functioning and unemployment was primarily driven by deficits in executive functions, learning, verbal fluency, and working memory.
CONCLUSION: These findings indicate that neurocognitive deficits play a significant role in the higher unemployment rates of MA-dependent individuals, and highlight the need for vocational rehabilitation and supported employment programs that assess and bolster cognitive skills in this population.
Clin Gerontol. 2011 Oct;34(5):413-426.
Vance DE, Wadley VG, Crowe MG, Raper JL, Ball KK.
School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
The purpose of this study was to: (1) examine cognitive performance differences in older and younger adults with and without HIV, and (2) determine if such differences were related to a laboratory measure of instrumental activities of daily living (IADLs). Ninety-eight HIV-positive (69 younger, 29 older) and 103 HIV-negative (84 younger, 19 older) adults were evaluated on a number of cognitive measures. Controlling for a number of confounders, age by HIV status interactions were found on two cognitive measures, indicating poorer cognitive performance for those aging with HIV. Poorer performance on these cognitive measures corresponded with poorer performance on the Timed Instrumental Activities of Daily Living (TIADL) test. These findings suggest that as adults age with HIV, they may be at risk for cognitive declines that would impair their ability to engage in activities important for maintaining independent living.
Dis Model Mech. 2012 May;5(3):313-22. Epub 2012 Mar 22.
Modeling HIV-associated neurocognitive disorders in mice: new approaches in the changing face of HIV neuropathogenesis.
Jaeger LB, Nath A.
Section of Infections of the Nervous System, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.
It is well established that infection with the human immunodeficiency virus (HIV) leads to immune suppression. Less well known is the fact that long-term, progressive HIV disease is associated with the development of cognitive deficits. Since the introduction of combined antiretroviral therapy (cART), the clinical presentation of HIV infection has evolved into a chronic illness with very low levels of viral replication and chronic immune activation, with compliant affected individuals surviving for decades with a high quality of life. Despite these advances, many HIV-infected individuals develop some degree of neurodegeneration and cognitive impairment. The underlying pathophysiological mechanisms are not well understood, and there are no effective treatments. Thus, there is an unmet need for animal models that enable the study of HIV-associated neurocognitive disorders (HAND) and the testing of new therapeutic approaches to combat them. Here, we review the pros and cons of existing mouse models of HIV infection for addressing these aims and propose a detailed strategy for developing a new mouse model of HIV infection.
J Neurovirol. 2012 May 3. [Epub ahead of print]
A diffusion tensor imaging and neurocognitive study of HIV-positive children who are HAART-naïve “slow progressors”
Hoare J, Fouche JP, Spottiswoode B, Donald K, Philipps N, Bezuidenhout H, Mulligan C, Webster V, Oduro C, Schrieff L, Paul R, Zar H, Thomas K, Stein D.
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/e84n2qp4r34754m8/
There are few neuropsychological or neuroimaging studies of HIV-positive children with “slow progression”. “Slow progressors” are typically defined as children or adolescents who were vertically infected with HIV, but who received no or minimal antiretroviral therapy. We compared 12 asymptomatic HIV-positive children (8 to 12 years) with matched controls on a neuropsychological battery as well as diffusion tensor imaging in a masked region of interest analysis focusing on the corpus callosum, internal capsule and superior longitudinal fasciculus. The “slow progressor” group performed significantly worse than controls on the Wechsler Abbreviated Scale of Intelligence Verbal and Performance IQ scales, and on standardised tests of visuospatial processing, visual memory and executive functioning. “Slow progressors” had lower fractional anisotropy (FA), higher mean diffusivity (MD) and radial diffusivity (RD) in the corpus callosum (p = <0.05), and increased MD in the superior longitudinal fasciculus, compared to controls. A correlation was found between poor performance on a test of executive function and a test of attention with corpus callosum FA, and a test of executive function with lowered FA in the superior longitudinal fasiculus. These data suggest that demyelination as reflected by the increase in RD may be a prominent disease process in paediatric HIV infection.
Brain Res. 2012 Apr 11. [Epub ahead of print]
Accumulation of nuclear and mitochondrial DNA damage in the frontal cortex cells of patients with HIV-associated neurocognitive disorders.
Zhang Y, Wang M, Li H, Zhang H, Shi Y, Wei F, Liu D, Liu K, Chen D.
Department of Medicine, Beijing You An Hospital, Capital Medical University, Beijing, China; Beijing Institute of Liver Disease, Beijing, China.
Oxidative stress has been suggested to play a key role in the neuropathogenesis of HIV infection. HIV proteins (gp120, Tat) and proinflammatory cytokines can trigger the production of reactive oxygen species (ROS), resulting in DNA and RNA lesions. Among all the lesions induced by ROS, one of the most abundant lesions in DNA and RNA is 8-hydroxydeoxyguanosine (8-oxoG). Here, we studied accumulated DNA oxidative damage induced by ROS in the central nervous system (CNS) in tissue from neuro-AIDS patients. The frontal cortex of autopsy tissue from HIV-1 infected patients was adopted for analysis for HIV-1 subtype, nuclear and mitochondrial DNA lesions by immunofluorescence staining, qPCR and sequencing of PCR cloning. This study provides evidence that HIV infection in the CNS leads to nuclear and mitochondrial genomic DNA damage in the brain. High level of nuclear and mtDNA 8-oxoG damage were identified in the cortex autopsy tissue of HAND patients. Increased accumulation of mtDNA mutations and depletion occurs in brain tissue in a subset of HAND cases, and is significantly different from that observed in control cases. These findings suggest that higher level of ROS in the CNS of HAND patients would contribute to the HIV induced neuro-inflammation and apoptosis of neuronal and glial cells.
AIDS Behav. 2012 May 9. [Epub ahead of print]
Homophobia is Associated with Sexual Behavior that Increases Risk of Acquiring and Transmitting HIV Infection Among Black Men Who Have Sex with Men.
Jeffries WL 4th, Marks G, Lauby J, Murrill CS, Millett GA.
Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-37, Atlanta, GA, 30333, USA, firstname.lastname@example.org.
We investigated whether the experience of homophobic events increases the odds of engaging in unprotected anal intercourse (UAI) among black men who have sex with men (MSM) and whether social integration level buffered the association. Participants (N = 1,154) reported homophobic events experienced in the past 12 months. Social integration measures included social support, closeness with family members and friends, attachment to the black gay community, openness about sexuality within religious communities, and MSM social network size. Logistic regression analyses indicated that experiencing homophobia was associated with (1) UAI among men not previously diagnosed with HIV and (2) sexual HIV transmission risk behavior among men who knew they were HIV-infected. None of the social integration measures buffered these associations. Homophobia may promote acquisition and transmission of HIV infection among black MSM. Interventions are needed to reduce homophobia experienced by black MSM.
AIDS Care. 2012 May 9. [Epub ahead of print]
A randomized control trial of personalized cognitive counseling to reduce sexual risk among HIV-infected men who have sex with men.
Schwarcz SK, Chen YH, Murphy JL, Paul JP, Skinta MD, Scheer S, Vittinghoff E, Dilley JW.
School of Medicine , University of California , San Francisco , USA.
The increased life expectancy and well-being of HIV-infected persons presents the need for effective prevention methods in this population. Personalized cognitive counseling (PCC) has been shown to reduce unprotected anal intercourse (UAI) with a partner of unknown or different serostatus among HIV-uninfected men who have sex with men (MSM). We adapted PCC for use among HIV-infected MSM and tested its efficacy against standard risk-reduction counseling in a randomized clinical trial in San Francisco. Between November 2006 and April 2010, a total of 374 HIV-infected MSM who reported UAI with two or more men of negative or unknown HIV serostatus in the previous 6 months were randomized to two sessions of PCC or standard counseling 6 months apart. The primary outcome was the number of episodes of UAI with a non-primary male partner of different or unknown serostatus in the past 90 days, measured at baseline, 6, and 12 months. Surveys assessed participant satisfaction with the counseling. The mean number of episodes of UAI at baseline did not differ between PCC and control groups (2.97 and 3.14, respectively; p=0.82). The mean number of UAI episodes declined in both groups at 6 months, declined further in the PCC group at 12 months, while increasing to baseline levels among controls; these differences were not statistically significant. Episode mean ratios were 0.76 (95% confidence interval [CI] 0.25-2.19, p=0.71) at 6 months and 0.48 (95% CI 0.12-1.84, p=0.34) at 12 months. Participants in both groups reported a high degree of satisfaction with the counseling. The findings from this randomized trial do not support the efficacy of a two-session PCC intervention at reducing UAI among HIV-infected MSM and indicate the continued need to identify and implement effective prevention methods in this population.
PLoS One. 2012;7(1):e31184. Epub 2012 Jan 27.
Population Size Estimation of Men Who Have Sex with Men through the Network Scale-Up Method in Japan.
Ezoe S, Morooka T, Noda T, Sabin ML, Koike S.
Evidence, Strategy and Results Department, The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0031184
BACKGROUND: Men who have sex with men (MSM) are one of the groups most at risk for HIV infection in Japan. However, size estimates of MSM populations have not been conducted with sufficient frequency and rigor because of the difficulty, high cost and stigma associated with reaching such populations. This study examined an innovative and simple method for estimating the size of the MSM population in Japan. We combined an internet survey with the network scale-up method, a social network method for estimating the size of hard-to-reach populations, for the first time in Japan.
METHODS AND FINDINGS: An internet survey was conducted among 1,500 internet users who registered with a nationwide internet-research agency. The survey participants were asked how many members of particular groups with known population sizes (firepersons, police officers, and military personnel) they knew as acquaintances. The participants were also asked to identify the number of their acquaintances whom they understood to be MSM. Using these survey results with the network scale-up method, the personal network size and MSM population size were estimated. The personal network size was estimated to be 363.5 regardless of the sex of the acquaintances and 174.0 for only male acquaintances. The estimated MSM prevalence among the total male population in Japan was 0.0402% without adjustment, and 2.87% after adjusting for the transmission error of MSM.
CONCLUSIONS: The estimated personal network size and MSM prevalence seen in this study were comparable to those from previous survey results based on the direct-estimation method. Estimating population sizes through combining an internet survey with the network scale-up method appeared to be an effective method from the perspectives of rapidity, simplicity, and low cost as compared with more-conventional methods.
Sex Transm Infect. 2012 May 5. [Epub ahead of print]
Katz DA, Dombrowski JC, Swanson F, Buskin SE, Golden MR, Stekler JD.
Department of Epidemiology, University of Washington, Seattle, Washington.
Objectives: The authors examined temporal trends and correlates of HIV testing frequency among men who have sex with men (MSM) in King County, Washington.
Methods: The authors evaluated data from MSM testing for HIV at the Public Health-Seattle & King County (PHSKC) STD Clinic and Gay City Health Project (GCHP) and testing history data from MSM in PHSKC HIV surveillance. The intertest interval (ITI) was defined as the number of days between the last negative HIV test and the current testing visit or first positive test. Correlates of the log(10)-transformed ITI were determined using generalised estimating equations linear regression.
Results: Between 2003 and 2010, the median ITI among MSM seeking HIV testing at the STD Clinic and GCHP were 215 (IQR: 124-409) and 257 (IQR: 148-503) days, respectively. In multivariate analyses, younger age, having only male partners and reporting ≥10 male sex partners in the last year were associated with shorter ITIs at both testing sites (p<0.05). Among GCHP attendees, having a regular healthcare provider, seeking a test as part of a regular schedule and inhaled nitrite use in the last year were also associated with shorter ITIs (p<0.001). Compared with MSM testing HIV negative, MSM newly diagnosed with HIV had longer ITIs at the STD Clinic (median of 278 vs 213 days, p=0.01) and GCHP (median 359 vs 255 days, p=0.02).
Conclusions: Although MSM in King County appear to be testing at frequent intervals, further efforts are needed to reduce the time that HIV-infected persons are unaware of their status.
Arch Sex Behav. 2012 May 5. [Epub ahead of print]
Li G, Lu H, Li X, Sun Y, He X, Fan S, McFarland W, Jia Y, Raymond HF, Xiao Y, Ruan Y, Shao Y.
Beijing Center for Disease Control and Prevention, Beijing, People’s Republic of China.
Abstract/1st page image: http://www.springerlink.com/content/yrjgl2m433347604/
HIV is rising rapidly among Chinese men who have sex with men (MSM). Discussion of HIV status between sexual partners is potentially a key prevention behavior. It is unclear if HIV-negative Chinese MSM talk about HIV and disclose their HIV status with sexual partners. Understanding the correlates of disclosure among this population could provide insight into developing disclosure-based interventions. We conducted a respondent driven sampling based study of 500 MSM in Beijing. A total of 332 men had a previous HIV-negative test result and thus considered themselves to be HIV-negative and were included in our analysis of disclosure. Equal numbers of these men reported talking about HIV and disclosing their HIV status to at least one sexual partner. MSM who disclosed were more likely to be living with a main partner. No other demographic characteristics were associated with disclosure in bivariate analysis. We also used data on up to three sexual partners per participant to examine disclosure on the partnership level. Main partnerships, meeting partners at bars/clubs, sometimes using alcohol before sex in a partnership, and usually having sex at home compared to other venues were associated with disclosure. Using generalized estimating equation analysis to characterize individuals from their partnership data, we found only having at least one main partnership and knowing people who were infected with HIV to be associated with a participant being a discloser. Interventions that wish to harness discussion of HIV and HIV status among Chinese MSM will need to focus on moving these discussions towards having them with casual partners.
Eur J Contracept Reprod Health Care. 2012 Jun;17(3):219-28.
Correlates of consistent condom use among young migrant men who have sex with men (MSM) in Beijing, China.
Liu Y, Li X, Zhang L, Li S, Jiang S, Stanton B.
Chaoyang District Centre for Disease Control and Prevention , Beijing , China.
Objectives The prevalence of sexually transmitted infections (STIs), including HIV, among men who have sex with men (MSM) has risen in China, mainly due to unprotected sexual intercourse. Migrant MSM might be more vulnerable to the risk of STIs/HIV because of their low socioeconomic status. This study aims at exploring the correlates of consistent condom use among young migrant MSM (aged 18-29 years) in Beijing.
Methods Multivariate logistic regression analysis.
Results The mean age of the sample was 23.7 years. Rural-to-urban migrant MSM accounted for 46% of the sample, and urban-to-urban migrant MSM for 54%. Of 307 migrant MSM, 178 (54%) reported having used a condom every time in the last three sexual episodes with both stable and casual sexual partners. Multivariate logistic regression analysis showed that MSM who had a low monthly income, had often experienced alcohol intoxication, did not use a condom at first sex, and had fewer lifetime male sexual partners were less likely to use condoms consistently.
Conclusions Consistent condom use among young migrant MSM was relatively low and was associated with socioeconomic status and alcohol use. Future STIs/HIV prevention programmes should strengthen empowerment, access to condoms, and reduction of alcohol consumption within this socio-economically marginalised group.
Health Educ Behav. 2012 May 4. [Epub ahead of print]
Predicting Condom Use Attitudes, Norms, and Control Beliefs in Hispanic Problem Behavior Youth: The Effects of Family Functioning and Parent-Adolescent Communication About Sex on Condom Use.
Malcolm S, Huang S, Cordova D, Freitas D, Arzon M, Jimenez GL, Pantin H, Prado G.
Hispanic problem behavior youth are at an increased risk of engaging in HIV risk behaviors, including low condom use. However, relatively little research has examined factors that affect condom use in this population. Although research indicates that family processes, such as higher levels of family functioning and open parent-adolescent communication about sex, and condom use attitudes, norms, and control beliefs as depicted by the theory of planned behavior have an effect on condom use behaviors, the combination of the two factors has received minimal attention. The purpose of this study was to examine the effect of family functioning on condom use intentions and behaviors through communication about sex and condom use attitudes, parental norms, and control beliefs. A cross-sectional study of 171 predominately male (73.1%) sexually active Hispanic problem behavior adolescents (mean age = 14.88 years) was conducted. Structural equation modeling was used to test the study hypothesis. Findings largely support the overall model and suggest that family functioning had an indirect effect on condom use intention and behavior through communication about sex, condom use attitudes, and control beliefs. Family functioning, however, did not have an indirect effect on condom use intention and behavior through communication about sex and parental norms. Implications for prevention science and future research are discussed.
Prevention of sexually transmitted infections in urban communities (Peru PREVEN): A multicomponent community-randomised controlled trial
Lancet. 24 March 2012; 379(9821):1120-8.
Garcia PJ, Holmes KK, Carcamo CP, Garnett GP, et al.
Background: Previous community-randomised trials of interventions to control sexually transmitted infections (STIs) have involved rural settings, were rarely multicomponent, and had varying results. We aimed to assess the effect of a multicomponent intervention on curable STIs in urban young adults and female sex workers (FSWs).
Methods: In this community-randomised trial, baseline STI screening was done between August, and November, 2002, in random household samples of young adults (aged 18-29 years) and in FSWs in Peruvian cities with more than 50 000 inhabitants. Geographically separate cities were selected, matched into pairs, and randomly allocated to intervention or control groups with an S-PLUS program. Follow-up surveys of random samples were done after 2 years and 3 years. The intervention comprised four modalities: strengthened STI syndromic management by pharmacy workers and clinicians; mobile-team outreach to FSWs for STI screening and pathogen-specific treatment; periodic presumptive treatment of FSWs for trichomoniasis; and condom promotion for FSWs and the general population. Individuals in control cities received standard care. The composite primary endpoint was infection of young adults with Chlamydia trachomatis, Trichomonas vaginalis, or Neisseria gonorrhoeae, or syphilis seroreactivity. Laboratory workers and the data analyst were masked, but fieldworkers, the Peruvian study team, and participants in the outcome surveys were not. All analyses were done by intention to treat.
Findings: We did baseline surveys of 15 261 young adults in 24 Peruvian cities. Of those, 20 geographically separate cities were matched into pairs, in each of which one city was assigned to intervention and the other to standard of care. In the 2006 follow-up survey, data for the composite primary outcome were available for 12 930 young adults. We report a non-significant reduction in prevalence of STIs in young adults, adjusted for baseline prevalence, in intervention cities compared with control cities (relative risk 0.84, 95% CI 0.69-1.02; p=0.096). In subgroup analyses, significant reductions were noted in intervention cities in young adult women and FSWs.
Interpretation: Syndromic management of STIs, mobile-team outreach to FSWs, presumptive treatment for trichomoniasis in FSWs, and condom promotion might reduce the composite prevalence of any of the four curable STIs investigated in this trial.
AIDS Behav. 2012 May 4. [Epub ahead of print]
Leibowitz AA, Harawa N, Sylla M, Hallstrom CC, Kerndt PR.
Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/d251238475696n51/
To determine if a structural intervention of providing one condom a week to inmates in the Los Angeles County Men’s Central Jail MSM unit reduces HIV transmissions and net social cost, we estimated numbers of new HIV infections (1) when condoms are available; and (2) when they are not. Input data came from a 2007 survey of inmates, the literature and intervention program records. Base case estimates showed that condom distribution averted 1/4 of HIV transmissions. We predict .8 new infections monthly among 69 HIV-negative, sexually active inmates without condom distribution, but .6 new infections with condom availability. The discounted future medical costs averted due to fewer HIV transmissions exceed program costs, so condom distribution in jail reduces total costs. Cost savings were sensitive to the proportion of anal sex acts protected by condoms, thus allowing inmates more than one condom per week could potentially increase the program’s effectiveness.
Posit Aware. 2011 Jul-Aug;23(5):25-7.
PDF of full issue: http://positivelyaware.com/2011/11_05/pdfs/11_05.pdf
Just as the blue Viagra pill revolutionized sex, the blue HIV drug Truvada is set to revolutionize the epidemic. It is poised to become FDA-approved, as early as this year, for HIV prevention. But in fact, the blue Truvada tablet, with “Gilead” stamped on one side and the numbers “701” on the other, is already being prescribed to HIV-negative people for prevention, under what’s called “offlabel” usage. The strategy, based on success shown in animal studies, is one that’s not widely known, even in groups at the highest risk of infection, such as gay men…
J Nonnewton Fluid Mech. 2011 Oct;166(19-20):1116-1122.
Tasoglu S, Park SC, Peters JJ, Katz DF, Szeri AJ.
Department of Mechanical Engineering, University of California, Berkeley, CA
A recent study in South Africa has confirmed, for the first time, that a vaginal gel formulation of the antiretroviral drug Tenofovir, when applied topically, significantly inhibits sexual HIV transmission to women . However the gel for this drug, and anti-HIV microbicide gels in general, have not been designed using full understanding of how gel spreading and retention in the vagina govern successful drug delivery. Elastohydrodynamic lubrication theory can be applied to model such spreading of microbicide gels, which are inherently non-Newtonian [13,15]. A yield stress is emerging as one of the important properties of microbicide gel vehicle deployment, as this may improve retention within the vaginal canal. On the other hand, a yield stress may decrease the initial extent of the coating flow. Here, we first explain a certain yield stress paradox observed generally in many lubrication flows. Four conditions are determined, via scaling analysis, which mitigate the inconsistency in the use of lubrication theory to analyze the specific problem of elastic wall squeezing flow of yield stress fluid. Parameters characterizing these conditions are obtained experimentally for a test gel. Using them, it is shown that the lubrication approximation may be applied to the elastic wall-squeezing problem for this gel.
An Bras Dermatol. 2012 Apr;87(2):197-202.
Miranda AE, Lima BM, Giami A, Golub JE, Talhari S.
Department of Social Medicine, Federal University of Espírito Santo, Vitória, ES, Brazil.
BACKGROUND: Studies about sexual risk behaviors can provide information to support design strategies to control the spread of HIV infection.
OBJECTIVE: To assess sexual risk behaviors among women attending a sexually transmitted diseases clinic in Vitória, Brazil.
METHODS: A cross-sectional study was performed among women attending an STD/AIDS reference center. Enrolled participants were interviewed and provided a blood sample to determine HIV status.
RESULTS: A total of 276 women participated. among 284 selected; 109 (39.5%) were HIV-positive and 167 (60.5%) HIV-negative. Median age was 31 years (interquartile range (IQR)24-36) and 69% of women were between 18 and 34 years of age. Women reported high access to information about STD (87%) and AIDS (90%) but information about sexuality was less common (55%). HIV-positive women asked their partners to use condoms more often than HIV-negatives (31% vs. 5%, p=0.02), and were more likely to have used a condom at last intercourse (65% vs. 33%, p<0.01). Among all patients, questions regarding risk of HIV transmission through sexual intercourse (99.6%) and needle sharing (99.2%) were most frequently answered correctly, while questions regarding risk of HIV transmission through blood donation (57%) were least.
CONCLUSION: Though this population reports easy access to information and services for HIV/sexually transmitted diseases, most report little understanding of unsafe sexual behaviors, particularly HIV-negative women.
BMC Public Health. 2012 May 2;12(1):325. [Epub ahead of print]
Transactional relationships and sex with a woman in prostitution: prevalence and patterns in a representative sample of South African men.
Jewkes R, Morrell R, Sikweyiya Y, Dunkle K, Penn-Kekana L.
BACKGROUND: Sex motivated by economic exchange is a public health concern as a driver of the Sub-Saharan African HIV epidemic. We describe patterns of engagement in transactional sexual relationships and sex with women in prostitution of South African men, and suggest interpretations that advance our understanding of the phenomenon.
METHODS: Cross-sectional study with a randomly-selected sample of 1645 sexually active men aged 18-49 years who completed interviews in a household study and were asked whether they had had sex with a woman in prostitution, or had had a relationship or sex they took to be motivated by the expectation of material gain (transactional sex).
RESULTS: 18% of men had ever had sex with a woman in prostitution, 66% at least one type of transactional sexual relationship, only 30% of men had done neither. Most men had had a transactional relationship/sex with a main partner (58% of all men), 42% with a concurrent partner (or makhwapheni) and 44% with a once off partner, and there was almost no difference in reports of what was provided to women of different partner types. The majority of men distinguished the two types of sexual relationships and even among men who had once-off transactional sex and gave cash (n=314), few (34%) reported that they had had sex with a ‘prostitute’. Transactional sex was more common among men aged 25-34 years, less educated men and low income earners rather than those with none or higher income. Having had sex with a woman in prostitution varied little between social and demographic categories, but was less common among the unwaged or very low earners.
CONCLUSIONS: The notion of ‘transactional sex’ developed through research with women does not translate easily to men. Many perceive expectations that they fulfil a provider role, with quid pro quo entitlement to sex. Men distinguished these circumstances of sex from having sex with a woman in prostitution. Whilst there may be similarities, when viewed relationally, these are quite distinct practices. Conflating them is sociologically inappropriate. Efforts to work with men to reduce transactional sex should focus on addressing sexual entitlement and promoting gender inequity.
AIDS Behav. 2012 May 6. [Epub ahead of print]
A Two-Way Road: Rates of HIV Infection and Behavioral Risk Factors Among Deported Mexican Labor Migrants.
Rangel MG, Martinez-Donate AP, Hovell MF, Sipan CL, Zellner JA, Gonzalez-Fagoaga E, Kelley NJ, Asadi-Gonzalez A, Amuedo-Dorantes C, Magis-Rodriguez C.
El Colegio de la Frontera Norte, Tijuana, Mexico.
Abstract/1st page image: http://www.springerlink.com/content/598436772h516546/
A large number of Mexican migrants are deported to Mexico and released in the North Mexican border region every year. Despite their volume and high vulnerability, little is known about the level of HIV infection and related risk behaviors among this hard-to-reach population. We conducted a cross-sectional, probability survey with deported Mexican migrants in Tijuana, Mexico (N = 693) and estimated levels of HIV infection and behavioral risk factors among this migrant flow. The sample and population estimated rates of HIV for deported males were 1.23 and 0.80 %, respectively. No positive cases were found among the female sample. We found high lifetime rates of reported sexually transmitted infections (22.3 %) and last 12-months rates of unprotected sex (63.0 %), sex with multiple sexual partners (18.1 %), casual partners (25.7 %), and sex workers (8.6 %), compared to U.S. and Mexico adults. HIV prevention, testing, and treatment programs for this large, vulnerable, and transnational population need to be implemented in both the U.S. and Mexico.
Arch Sex Behav. 2012 May 3. [Epub ahead of print]
Department of Sociology, Memorial University of Newfoundland, St. John’s, NL, Canada, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/vj5361w7p7017724/
Recent evidence across sub-Saharan Africa shows married women face heightened risks of contracting HIV compared to the never-married. Vulnerability of married women to HIV infection is linked to a number of factors including their inability to negotiate safer sex, inter alia, asking their husbands to use condoms or refusing sexual intercourse even in high risk situations. This study examined what influences married women’s ability to say they can ask their sexual partners to use condoms or refuse sexual intercourse. Demographic and Health Survey data from 2,950 married women were analyzed using complementary log-log models. Married women in Ghana were more likely to say they can ask their husbands to use condoms when they know condoms can protect against HIV transmission and had been tested for their HIV serostatus. Also, women who know sexual abstinence can protect against HIV transmission were more likely to say they can refuse sex. Wealthier and highly educated women were more likely to say they can refuse to have sex with their husbands or ask them to use condoms, compared to poorer and less educated women. It is recommended that policy makers promote specific knowledge related to HIV prevention (condom use, HIV testing), while improving the social and economic circumstances of married women in Ghana.
HIV Testing, Diagnosis, Epidemological Issues (e.g. prevalence, incidence, mortality) Article Summaries
PLoS One. 2012;7(4):e35212. Epub 2012 Apr 27.
Acceptability and Feasibility of Universal Offer of Rapid Point of Care Testing for HIV in an Acute Admissions Unit: Results of the RAPID Project.
Burns F, Edwards SG, Woods J, Haidari G, Calderon Y, Leider J, Morris S, Tobin R, Cartledge J, Brown M.
Research Department of Infection & Population Health, University College London, London, United Kingdom.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0035212
BACKGROUND: UK guidance recommend all acute medical admissions be offered an HIV test. Our aim was to determine whether a dedicated staff member using a multimedia tool, a model found to be effective in the USA, is an acceptable, feasible, and cost-effective model when translated to a UK setting.
DESIGN: Between 14(th) Jan to 12(th) May 2010, a Health advisor (HA) approached 19-65 year olds at a central London acute medical admissions unit (AAU) and offered a rapid HIV point of care test (POCT) with the aid of an educational video. Patients with negative results had the option to watch a post-test video providing risk-reduction information. For reactive results the HA arranged a confirmatory test, and ensured linkage into HIV specialist care. Feasibility and acceptability were assessed through surveys and uptake rates. Costs per case of HIV identified were established.
RESULTS: Of the 606 eligible people admitted during the pilot period, 324 (53.5%) could not be approached or testing was deemed inappropriate. In total 23.0% of eligible admissions had an HIV POCT. Of the patients who watched the video and had not recently tested for HIV, 93.6% (131/140) agreed to an HIV test; four further patients had an HIV test but did not watch the video. Three tests (2.2%, 3/135) were reactive and all were confirmed HIV positive on laboratory testing. 97.5% felt HIV testing in this setting was appropriate, and 90.1% liked receiving the information via video. The cost per patient of the intervention was £21.
DISCUSSION: Universal POCT HIV testing in an acute medical setting, facilitated by an educational video and dedicated staff appears to be acceptable, feasible, effective, and low cost. These findings support the recommendation of HIV testing all admissions to AAU in high prevalence settings, although with the model used a significant proportion remained untested.
Enferm Infecc Microbiol Clin. 2012 May 4. [Epub ahead of print]
[Article in Spanish]
De Mulder M, Holguín A.
Laboratorio de Epidemiología Molecular del VIH-1, Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal-Instituto Ramón y Cajal de Investigaciones Sanitarias (IRyCIS) y CIBER-ESP, Madrid, España.
As access to antiretroviral treatment increases in the developing countries, efforts towards making it easier and less costly to collect, store, and deliver the biological samples to reference laboratories, where the serological and genetic diagnosis techniques are performed, have become a high priority. Blood sampling on filter papers is an inexpensive and practical alternative to plasma for antiretroviral treatment monitoring in countries with limited resources and no access to cold chains or refrigeration. The main clinical applications and uses of blood-sampling onto filter papers (dried blood spots [DBS]) are reviewed, focusing on how these can be applied in monitoring HIV infection, particularly for use in National Health Programs in developing countries, or in resource-limited settings. A review is presented of studies that have used the DBS technique for quantifying viral load, analysis of antiretroviral drug-resistance mutations, early infant diagnosis, adult serological diagnosis, detection of viral p24 antigen, and molecular epidemiology of HIV-1, in different geographical locations. Those variables that could affect the use of DBS, particularly in the HIV field, as well as explaining how these procedures can be optimised to increase their sensitivity are also reviewed. The aim of this study was to review the advantages of implementing the DBS technique in the HIV field, especially in resource-constrained regions.
AIDS. 2012 May 2. [Epub ahead of print]
Crémieux AC, D’Almeida KW, de Truchis P, Simon F, le Strat Y, Bousquet V, Semaille C, le Vu S, Lert F.
Hôpital Raymond-Poincaré, AP-HP, Garches, France; Université Versailles-Saint-Quentin, Faculté de Médecine Paris Île-de-France Ouest, France…
To estimate the 2009-2010 undiagnosed-HIV prevalence in the Paris metropolitan region, where half of France’s new HIV cases are diagnosed annually, we used a direct method based on a large sample of emergency department patients unaware of their HIV status. The overall expected prevalence was 0.09% (95% confidence interval 0.04-0.13). Undiagnosed infections were exclusively found in high-risk groups. This prevalence is below the 0.1% threshold suggested by regulatory authorities for implementing universal screening.
Gac Sanit. 2012 May 1. [Epub ahead of print]
[Article in Spanish]
Gorostiza I, López de Landache IE, Braceras Izagirre L.
Unidad de Investigación, Hospital de Basurto, Osakidetza, Bilbao, España.
OBJECTIVES: To describe the outcomes of the pilot program of a rapid HIV antibody screening test offered at Basque pharmacies, the socio-demographic characteristics of users and their acceptance of the test.
METHODS: Users of a rapid HIV antibody screening test (20 pharmacies) were surveyed. A random sample of 3514 tests (N = 806) performed in 1 year was taken. Statistical analyses included exact tests.
RESULTS: There were 806 valid questionnaires. Seven tests were positive (0.85%; 95% confidence interval: 0.34-1.75); five of the users with positive tests were men. The mean age was 36.2 years (standard deviation = 11.0; range: 16-82 years; 70.7% men). Users’ risk behavior was predominantly heterosexual and half of the users (58.6%) had no previous HIV tests. The main reasons for choosing this test were its speed, and the convenience and accessibility of community pharmacies.
CONCLUSIONS: This new rapid HIV antibody screening test in community pharmacies could supplement other HIV screening programs currently in operation.
Braz J Infect Dis. 2012 Apr;16(2):157-63.
Recent HIV infection rates among HIV positive patients seeking voluntary counseling and testing centers in the metropolitan region of Recife – Pe, Brazil.
Cavalcanti AM, Brito AM, Salustiano DM, Lima KO, Silva SP, Lacerda HR.
Virology Division, Laboratório Central de Saúde Pública de Pernambuco, Recife, PE, Brazil.
The BED capture enzyme immunoassay test makes it possible to determine whether individuals were recently infected with HIV.
OBJECTIVE: In this study, the overall HIV and recent infections prevalences were determined at five Voluntary Counseling and Testing (VCT) centers, in the Metropolitan Region of Recife, Northeastern of Brazil.
MATERIAL AND METHODS: A cross-sectional study was conducted among users of five VCTs in the metropolitan region of Recife between July 2007 and April 2009. Out of the individuals who tested positive for HIV, 169 were analyzed to assess the prevalence of recent infection by means of the BED-CEIA (BED-Calypte®).
RESULTS: Out of 46,696 individuals tested 916 (1.96%) turned out positive for HIV infection The highest prevalence was in Recife (3.9%). The prevalence was higher among males (3.93%), and men who have sex with men (MSM) (12.4%). The frequency of recent infections among the 169 subjects evaluated was 23.7%. Recent infections were more common among individuals under 25 years of age. There was slight predominance of men and higher frequency of heterosexuals in both groups, but still a significant portion of MSM (33%). Subtype B predominated, followed by a high proportion of subtype F.
CONCLUSIONS: Recent infection occurs mainly among young individuals and heterosexuals, despite a significant proportion of recent infection among MSM. These results suggest that preventive actions aimed at the MSM community remains a challenge and efforts focusing this group should continue to be a priority.
Braz J Infect Dis. 2012 Apr;16(2):153-6.
JC virus-associated central nervous system diseases in HIV-infected patients in Brazil: clinical presentations, associated factors with mortality and outcome.
Piza F, Fink MC, Nogueira GS, Pannuti CS, Oliveira AC, Vidal JE.
Department of Infectious Diseases, Instituto de Infectologia Emílio Ribas, São Paulo, Brazil.
INTRODUCTION: Several presentations of neurologic complications caused by JC virus (JCV) in human immunodeficiency virus (HIV)-infected patients have been described and need to be distinguished from the “classic” form of progressive multifocal leukoencephalopathy (PMl). The objectives of this study were: 1) to describe the spectrum and frequency of presentations of JCV-associated central nervous system (CNS) diseases; 2) identify factors associated with in-hospital mortality of patients with JCV-associated CNS disease; and 3) to estimate the overall mortality of this population.
MATERIAL AND METHODS: This was a retrospective study of HIV-infected patients admitted consecutively for JCVassociated CNS diseases in a referral teaching center in São Paulo, Brazil, from 2002 to 2007. All patients with laboratory confirmed JCV-associated CNS diseases were included using the following criteria: compatible clinical and radiological features associated with the presence of JCV DNA in the cerebrospinal fluid. JCV-associated CNS diseases were classified as follows: 1) classic PMl; 2) inflammatory PMl; and 3) JC virus granule cell neuronopathy (GCN).
RESULTS: We included 47 cases. JCV-associated CNS diseases were classified as follows: 1) classic PMl: 42 (89%); 2) inflammatory PMl: three (6%); and 3) JC virus GCN: four (9%). Nosocomial pneumonia (p = 0.003), previous diagnosis of HIV infection (p = 0.03), and imaging showing cerebellar and/or brainstem involvement (p = 0.02) were associated with in-hospital mortality. overall mortality during hospitalization was 34%.
CONCLUSIONS: Novel presentations of JCV-associated CNS diseases were observed in our setting; nosocomial pneumonia, previous diagnosis of HIV infection, and cerebellar and/or brainstem involvement were associated with in-hospital mortality; and overall mortality was high.
PLoS One. 2012;7(4):e36381. Epub 2012 Apr 30.
Effectiveness of a Prevention of Mother-to-Child HIV Transmission Programme in an Urban Hospital in Angola.
Lussiana C, Clemente SV, Ghelardi A, Lonardi M, Pulido Tarquino IA, Floridia M.
Infectious Diseases Laboratory, Hospital Divina Providencia, Luanda, Angola.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0036381
BACKGROUND: Antiretroviral therapy is effective in reducing rates of mother-to child transmission of HIV to low levels in resource-limited contexts but the applicability and efficacy of these programs in the field are scarcely known. In order to explore such issues, we performed a descriptive study on retrospective data from hospital records of HIV-infected pregnant women who accessed in 2007-2010 the Luanda Municipal Hospital service for prevention of mother-to-child transmission (PMTCT). The main outcome measure was infant survival and HIV transmission. Our aim was to evaluate PMTCT programme in a local hospital setting in Africa.
RESULTS: Data for 104 pregnancies and 107 infants were analysed. Sixty-eight women (65.4%) had a first visit before or during pregnancy and received combination antiretroviral treatment (ART) in pregnancy. The remaining 36 women (34.6%) presented after delivery and received no ART during pregnancy. Across a median cohort follow-up time of 73 weeks, mortality among women with and without ART in pregnancy was 4.4% and 16.7%, respectively (death hazard ratio: 0.30, 95% CI 0.07-1.20, p = 0.089). The estimated rates of HIV transmission or death in the infants over a median follow up time of 74 weeks were 8.5% with maternal ART during pregnancy and 38.9% without maternal ART during pregnancy. Following adjustment for use of oral zidovudine in the newborn and exposure to maternal milk, no ART in pregnancy remained associated with a 5-fold higher infant risk of HIV transmission or death (adjusted odds ratio: 5.13, 95% CI: 1.31-20.15, p = 0.019).
CONCLUSIONS: Among the women and infants adhering to the PMTCT programme, HIV transmission and mortality were low. However, many women presented too late for PMTCT, and about 20% of infants did not complete follow up. This suggests the need of targeted interventions that maintain the access of mothers and infants to prevention and care services for HIV.
World Health Popul. 2012;13(3):5-17.
Infection with the human immunodeficiency virus and fertility desires: results from a qualitative study in rural Uganda.
Heys J, Jhangri G, Rubaale T, Kipp W.
Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
The rationale of this qualitative study was to determine how a positive HIV diagnosis influenced fertility desires and reproductive decisions for women and men living in western Uganda and what the reasons were behind these fertility desires. The qualitative study was undertaken as part of a larger study on the same topic in order to better understand the quantitative findings. Five focus groups with a total of 35 participants, 20 women and 15 men were conducted. Eighteen participants were HIV positive. Almost all HIV-positive participants reported that they did not wish to have more children. The most important reasons given were the devastating impact of HIV on the health of the mother and the high risk of HIV transmission to the child. Most participants were not aware of the benefits of highly active antiretroviral therapy on reducing the risk of mother-to-child transmission of HIV. Some HIV-negative participants viewed ongoing childbearing by HIV-positive individuals as the result of a lack of education regarding the risks of childbearing while HIV-positive and also as contrary to the current expectations of lifestyle practice. They also emphasized that the community’s perceptions of having children when mothers are HIV-infected was unfavorable and that fertility norms for all persons in the study area have now changed due to economic concerns and desire to educate all children in the family. The study findings have to be incorporated in the counselling curriculum for programs directed at HIV prevention and care and family planning. Specific recommendations are provided to improve the districts’ primary healthcare programs for HIV care/prevention and family planning.
PLoS One. 2012;7(4):e36039. Epub 2012 Apr 27.
High incidence of unplanned pregnancy after antiretroviral therapy initiation: findings from a prospective cohort study in South Africa.
Schwartz SR, Rees H, Mehta S, Venter WD, Taha TE, Black V.
Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0036039
BACKGROUND: Increased fertility rates in HIV-infected women receiving antiretroviral therapy (ART) have been attributed to improved immunological function; it is unknown to what extent the rise in pregnancy rates is due to unintended pregnancies.
METHODS: Non-pregnant women ages 18-35 from four public-sector ART clinics in Johannesburg, South Africa, were enrolled into a prospective cohort and followed from August 2009-March 2011. Fertility intentions, contraception and pregnancy status were measured longitudinally at participants’ routine ART clinic visits.
FINDINGS: Of the 850 women enrolled, 822 (97%) had at least one follow-up visit and contributed 745.2 person-years (PY) at-risk for incident pregnancy. Overall, 170 pregnancies were detected in 161 women (incidence rate [IR]: 21.6/100 PY [95% confidence interval (CI): 18.5-25.2]). Of the 170 pregnancies, 105 (62%) were unplanned. Unmet need for contraception was 50% higher in women initiating ART in the past year as compared to women on ART>1 year (prevalence ratio 1.5 [95% CI: 1.1-2.0]); by two years post-ART initiation, nearly one quarter of women had at least one unplanned pregnancy. Cumulative incidence of pregnancy was equally high among recent ART initiators and ART experienced participants: 23.9% [95% CI: 16.4-34.1], 15.9% [12.0-20.8], and 21.0% [16.8-26.1] for women on ART 0-1 yr, >1 yr-2 yrs, and >2 yrs respectively (log-rank, p = 0.54). Eight hormonal contraceptive failures were detected [IR: 4.4 [95% CI: 2.2-8.9], 7/8 among women using injectable methods. Overall 47% (80/170) of pregnancies were not carried to term.
CONCLUSIONS: Rates of unintended pregnancies among women on ART are high, including women recently initiating ART with lower CD4 counts and higher viral loads. A substantial burden of pregnancy loss was observed. Integration of contraceptive services and counselling into ART care is necessary to reduce maternal and child health risks related to mistimed and unwanted pregnancies. Further research into injectable contraceptive failures on ART is warranted.
AIDS. 2012 May 2. [Epub ahead of print]
Increased regression and decreased incidence of HPV-related cervical lesions among HIV-infected women on HAART.
Adler DH, Kakinami L, Modisenyane T, Tshabangu N, Mohapi L, De Bruyn G, Martinson NA, Omar T.
OBJECTIVE: To determine the impact of HAART on incidence, regression, and progression of cytopathological abnormalities in HIV-infected women.
DESIGN: Prospective cohort.
METHODS: HIV-infected women (N = 1123) from Soweto, South Africa underwent serial cervical smears that were analyzed and reported using the Bethesda system. The results of HAART and non-HAART users were compared using two statistical approaches: 1) A survival analysis assessing risk of incident smear abnormality among women with baseline normal smear results; and 2) Analysis with marginal models assessing for an association between HAART use and likelihood of regression/progression in consecutive smears.
RESULTS: After multivariate survival analysis, women using HAART with a normal baseline smear were 38% less likely to have an incident smear abnormality during follow-up than non-users (CI: 0.42 – 0.91; p = 0.01). Multivariate marginal models analysis identified a significantly increased likelihood (OR = 2.61; CI: 1.75 – 3.89; p < 0.0001) of regression of cervical lesions among women on HAART.
CONCLUSIONS: Our large prospective cohort study adds significant weight to the side of the balance of clinical research supporting the positive impact of HAART on the natural history of HPV-related cervical disease in HIV-infected women.
Womens Health (Lond Engl). 2012 May;8(3):313-21.
Gupta NK, Bowman CA.
Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Glossop Road, Sheffield, UK.
Sexually transmitted infections (STIs) constitute a major public health problem in the UK and may result in very costly complications. Many STIs pose the risk of a number of adverse pregnancy outcomes including miscarriage, still birth, preterm delivery, low birth weight and ophthalmia neonatorum. National guidelines for the management of STIs are produced and regularly revised by the British Association of Sexual Heath and HIV. This review outlines the latest recommended treatment options during pregnancy for the commonly encountered STIs.
Rev Chilena Infectol. 2012 Feb;29(1):87-94.
Prevention of vertical transmission of the human immunodeficiency virus type 1 in Uruguay: 1987-2009. An analysis of measures adopted
[Article in Spanish]
Quian R J, Gutiérrez R S, González C V, Visconti G A, Sicco C G, Murialdo E C, Lioni H M.
Centro VIH-SIDA Obstétrico Pediátrico, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay.
The prevention of vertical transmission (VT) of human immunodeficiency virus (HIV) is a priority as it generally is an avoidable disease.
Aim: To describe Uruguay’s experience of VT during 23 years and the preventive measures adopted.
Patients and Methods: Children of HIV positive mothers born between January 1987 and December 2009 were followed. The mother, pregnancy and children dependent variables were analysed. Infants were classified as infected, not infected, exposed but still in evaluation, or withdrawn of the protocol. The different measures implemented were analyzed.
Results: There were 1353 children of HIV positive mothers; 204 (15.1%) infants were infected. The percentage of VT diminished throughout the years; between 2003 and 2009 it decreased to 6%. Protective factors against HIV VT were antiretroviral therapy (ARV) during pregnancy, elective caesarean section and not to nurse the newborn infant. Women who did not receive AlRV had a percentage of VT of 50.3 %.
Conclusion: The VT has diminished in Uruguay. Special efforts must be done to screen all pregnant women, to improve diagnosis during pregnancy and to implement suitable ARV as occurs in developed countries.
Matern Child Health J. 2012 May 5. [Epub ahead of print]
Fertility Desires Among HIV-Infected Men and Women in Los Angeles County: Client Needs and Provider Perspectives.
Mindry D, Wagner G, Lake J, Smith A, Linnemayr S, Quinn M, Hoffman R.
Center for Culture and Health, Department of Psychiatry and Behavioral Sciences, NPI-Semel Institute for Neuroscience, University of California, Los Angeles, CA, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/g655773766xx8064/
Combination antiretroviral therapy for persons living with HIV/AIDS (PLHA) has extended life expectancy, and enabled PLHA to live productive lives that can include having children. Despite calls to address childbearing for PLHA there has been limited attention to developing safe conception programs. This research sought to assess the childbearing desires of PLHA and the experiences of health care providers serving this population. Research entailed a brief cross-sectional client survey given to HIV-infected men and women over age 18 at two Los Angeles County clinics administered over an 8-week period. Focus group discussions were conducted with providers at each clinic site. Although 39 % of the 93 clients surveyed reported a desire to have children, two-thirds of clients had not discussed their desires, or methods of safe conception, with providers. Providers reported challenges in providing safe conception services in resource poor settings where clients cannot afford assisted fertility services and in the absence of national, state, or county guidelines for safe conception. They noted complex and varied client circumstances and a critical need for provider training in safe conception. Guidelines that focus on safe conception and harm reduction strategies as well as the legal ramifications of counseling on these practices are needed. HIV providers need training and patients need educational tools and workshops informing them of the risks, challenges, and options available to them and their partners to safely conceive and bear an HIV-negative child.
Virulence. 2012 May 1;3(3). [Epub ahead of print]
Montague B, Rosen D, Solomon L, Nunn A, Green T, Costa M, Baillargeon J, Wohl D, Paar DP, Rich J, On Behalf Of The Lincs Study Group.
Brown University/Miriam Hospital; Providence, RI; University of North Carolina at Chapel Hill; Chapel Hill, NC.
Improving testing and uptake to care among highly impacted populations is a critical element of Seek, Test, Treat and Retain strategies for reducing HIV incidence in the community. HIV disproportionately impacts prisoners. Though, incarceration provides an opportunity to diagnose and initiate therapy, treatment is frequently disrupted after release. Though model programs exist to support linkage to care on release, there is a lack of scalable metrics with which to assess adequacy of linkage to care after release. The linking data from Ryan White program Client Level Data (CLD) files reported to HRSA with corrections release data offers an attractive means of generating these metrics. Identified only by use of a confidential encrypted Unique Client Identifier (eUCI) these CLD files allow collection of key clinical indicators across the system of Ryan White funded providers. Using eUCIs generated from corrections release data sets as a linkage tool, the time to the first service at community providers along with key clinical indicators of patient status at entry into care can be determined as measures of linkage adequacy. Using this strategy, high and low performing sites can be identified and best practices can be identified to reproduce these successes in other settings.
Am J Manag Care. 2012;18(4):207-12.
Saifu HN, Asch SM, Goetz MB, Smith JP, Graber CJ, Schaberg D, Sun BC.
Los Angeles, CA. E-mail: Hemen.Saifu@va.gov.
Background: Geographical barriers to subspecialty care may prevent optimal care of patients living in rural areas. We assess the impact of human immunodeficiency virus (HIV) and hepatitis C telemedicine consultation on patient-oriented outcomes in a rural Veterans Affairs population.
Methods: This was a pre- and post-intervention study comparing telemedicine with in-person subspecialty clinic visits for HIV and hepatitis C. Eligible patients resided in 2 rural catchment areas. The primary binary outcome was clinic completion. We estimated a logistic regression model with patient-level fixed effects. This approach controls for the clustering of visits by patient, uses each patient’s in-person clinic experience as an internal control group, and eliminates confounding by person-level factors. We also surveyed patients to assess satisfaction and patient-perceived reductions in health visit-related time.
Results: There were 43 patients who accounted for 94 telemedicine visits and 128 in-person visits. Clinic completion rates were higher for telemedicine (76%) than for in-person visits (61%). In regression analyses, telemedicine was strongly predictive of clinic completion (OR 2.2; 95% confidence interval [CI]: 1.0-4.7). The adjusted effect of telemedicine on clinic completion rate was 13% (95% CI: 12-13). Of the 30 patients (70%) who completed the survey, more than 95% rated telemedicine at the highest level of satisfaction and preferred telemedicine to in-person clinic visits. Patients reported a signifi cant reduction in health visit-related time (median 340 minutes, interquartile range 250-440), mostly due to decreased travel time.
Conclusions: HIV and hepatitis C telemedicine clinics are associated with improved access, high patient satisfaction, and reduction in health visit-related time.
J Immigr Minor Health. 2012 May 5. [Epub ahead of print]
Characteristics of Foreign-Born HIV Infected Individuals and Differences by Region of Origin and Gender.
Carten ML, Castillo-Mancilla JR, Allshouse AA, Johnson SC.
Division of Infectious Diseases and Foreign-Born Health and HIV Initiative, School of Medicine, University of Colorado Denver, Aurora, CO, Monica.firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/q5390447692l30xh/
To compare foreign-born (FB) and US-born (USB) patients (pts) in a US HIV care program. Retrospective review. Data were collected on all FB and a random sample of 5 % of USB pts in an HIV clinic in Colorado, USA. Comparisons were made between FB pts and USB pts and among FB pts by global region of origin and sex. Among 150 FB and 59 USB pts, FB pts were younger (40 vs. 45 years), proportionately more female (39 vs. 17 %), with heterosexual sex as HIV risk factor (69 vs. 23 %) and reported substance use less (6 vs. 38 %) (All p ≤ 0.001) compared to USB pts. Age and substance differences persisted between FB and USB women. Significant differences also existed between FB and USB pts in reason for HIV test, tuberculosis and mental health diagnoses, and diagnosis of >1 co-morbidity, but not in mean CD4 cell count (502 vs. 569), antiretroviral therapy (ART) (92 vs. 90 %), or alcohol use (29 vs. 37 %). Compared to FB women, FB men were more commonly men that have sex with men, from Latin America/Caribbean, have HIV testing for illness, and have had a concomitant HIV and AIDS diagnosis while FB women were more commonly refugees, heterosexual and from Africa. Differences exist between FB and USB HIV-infected pts, and among FB pts themselves. HIV care and prevention programs must recognize and address these dissimilarities in order to maximize clinical outcomes, improve linkage to and continuity in care and optimize resource allocation.
BMC Int Health Hum Rights. 2012 May 3;12(1):6. [Epub ahead of print]
HIV/AIDS stigma-associated attitudes in a rural Ethiopian community: characteristics, correlation with HIV knowledge and other factors, and implications for community intervention.
Lifson AR, Demissie W, Tadesse A, Ketema K, May R, Yakob B, Metekia M, Slater L, Shenie T.
BACKGROUND: Whether scale-up of HIV prevention and care will reduce negative attitudes and discriminatory practices towards persons living with HIV/AIDS (PLWH) is uncertain. An HIV knowledge and attitude survey was conducted in a rural Ethiopian community where HIV prevention and treatment was being rapidly scaled up. Data were analyzed to identify prevalence of and factors associated with stigma-associated attitudes towards PLWH.
METHODS: We surveyed 561 adults from 250 randomly selected households in the rural town of Arba Minch and surrounding villages about positive or negative attitudes towards PLWH, as well as demographic characteristics, and knowledge about HIV transmission and treatment.
RESULTS: Eighty percent of respondents agreed with [greater than or equal to] 1 negative statements indicating blame or shame towards PLWH and 41% agreed with [greater than or equal to] 1 negative statements associated with distancing themselves from PLWH. However, only 14% expressed negative responses about whether PLWH should receive support from their communities. In multivariate analysis, a greater number of negative attitudes towards PLWH was significantly (p < 0.05) associated with: female gender (Odds Ratio [OR] = 1.51), living in a rural village (vs. town neighborhood) (OR = 3.44), not knowing PLWH can appear healthy (OR = 1.78), lack of knowledge about perinatal transmission (OR = 1.49), lack of knowledge about how HIV is not transmitted (e.g. casual contact) (OR = 2.05), lack of knowledge about HIV treatment (OR = 1.80), and not personally knowing a PLWH (OR = 1.41).
CONCLUSIONS: In a rural Ethiopian setting in which rapid scale-up of HIV treatment occurred, many respondents still characterized HIV as associated with shame or blame, or indicated PLWH would be isolated or discriminated against. HIV stigma can hamper both prevention and treatment programs. We identified multiple issues which, if addressed, can help promote a more positive cycle in which PLWH are appreciated as members of one’s own community who are affirmatively interacted with and supported. Stigma reduction programs should address knowledge gaps such as fears of casual contact contagion, and lack of awareness of medical interventions to help prevent HIV disease, as well as building upon community-based attitudes of the importance of supporting and showing compassion for PLWH.
PLoS One. 2012;7(4):e35207.
Social, Structural and Behavioral Determinants of Overall Health Status in a Cohort of Homeless and Unstably Housed HIV-Infected Men.
Riley ED, Neilands TB, Moore K, Cohen J, Bangsberg DR, Havlir D.
Department of Medicine, University of California San Francisco, San Francisco, California
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0035207
BACKGROUND: Previous studies indicate multiple influences on the overall health of HIV-infected persons; however, few assess and rank longitudinal changes in social and structural barriers that are disproportionately found in impoverished populations. We empirically ranked factors that longitudinally impact the overall health status of HIV-infected homeless and unstably housed men.
METHODS AND FINDINGS: Between 2002 and 2008, a cohort of 288 HIV+ homeless and unstably housed men was recruited and followed over time. The population was 60% non-Caucasian and the median age was 41 years; 67% of study participants reported recent drug use and 20% reported recent homelessness. At baseline, the median CD4 cell count was 349 cells/µl and 18% of eligible persons (CD4<350) took antiretroviral therapy (ART). Marginal structural models were used to estimate the population-level effects of behavioral, social, and structural factors on overall physical and mental health status (measured by the SF-36), and targeted variable importance (tVIM) was used to empirically rank factors by their influence. After adjusting for confounding, and in order of their influence, the three factors with the strongest negative effects on physical health were unmet subsistence needs, Caucasian race, and no reported source of instrumental support. The three factors with the strongest negative effects on mental health were unmet subsistence needs, not having a close friend/confidant, and drug use. ART adherence >90% ranked 5th for its positive influence on mental health, and viral load ranked 4th for its negative influence on physical health.
CONCLUSIONS: The inability to meet food, hygiene, and housing needs was the most powerful predictor of poor physical and mental health among homeless and unstably housed HIV-infected men in an urban setting. Impoverished persons will not fully benefit from progress in HIV medicine until these barriers are overcome, a situation that is likely to continue fueling the US HIV epidemic.
Afr J Psychiatry (Johannesbg). 2012 Mar;15(2):94-8.
Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic.
Govender RD, Schlebusch L.
Department of Family Medicine, University of Kwa-Zulu Natal, Nelson R Mandela School of Medicine, Durban, South Africa.
OBJECTIVE: Suicidal behaviour and HIV/AIDS are significant public health concerns. The aim of this study was to investigate suicidal ideation in patients who were referred to a voluntary HIV counselling and testing (VCT) clinic and who were found to be seropositive. This in order to improve suicide prevention and intervention strategies amongst such patients.
METHOD: The sample studied consisted of volunteer adult patients referred over a three-month period to a HIVVCT clinic based at a university-affiliated general state hospital. Patients completed a questionnaire on sociodemographic data. Suicidal ideation was measured using the Beck Hopelessness Scale and the Beck Depression Inventory (BDI), at two time points (within 72 hours after notification and again at a 6 week follow-up). All patients received extensive pre-and post-test counselling.
RESULTS: HIV-test results were available for 189 (99.5%) of the original sample of 190 patients studied, with 157 (83.1%) testing positive. More females tested positive as did unemployed and single/divorced patients. The mean age for HIV-positive patients was 33.49 (SD = 9.449), and for HIV-negative patients it was 37.94 (SD = 15.238). Age was a significant factor in that for each year increase in age, the risk of testing HIV-positive decreased by 4.1%. Lower education and traditional beliefs were also significantly associated with testing HIV-positive. At 72 hours suicidal ideation was present in 17.1% (95% confidence interval 12.16% to 23.45%), and at 6 weeks in 24.1% (95% confidence interval 17.26% to 32.39%) of the seropositive patients. Their average BDI scores were 15.20 and 14.23 respectively at the two time points.
CONCLUSION: Suicidal ideation was present in a significant number of the seropositive cohort studied and increased over a six week period among these patients. The average BDI scores at both time points imply a clinical depression. The findings also suggest an association between positive HIV-test results and certain socio-demographic variables that can act as indicators for suicidal ideation in HIVhyphen;infected persons, although this requires further research. Although the relationship between suicidal ideation and HIV-infection is complex, it is an important consideration when assessing patient suicide vulnerability at HIV VCT clinics and when implementing suicide prevention and management strategies.
Rev Chilena Infectol. 2012 Feb;29(1):95-8.
[Article in Spanish]
Muñoz C C, Mansilla E JA, Heider C C, Leal W MJ, Chain A C.
Departamento de Cirugía, Universidad de La Frontera, Temuco, Chile.
Introduction: The ano-rectal pathology (ARP) is the most common surgical condition in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Our aim was to determine the current prevalence and clinical characteristics of the ARP in patients with HIV/AIDS in clinical control in the infectious diseases unit of the Hernán Henríquez Aravena Hospital in Temuco.
Patients and Method: Study design: Cross section.
Location and period: Infectious Diseases Unit of the hospital during the month of June 2010. Inclusion criteria: Patients with HIV/AIDS under control in the unit, medical records were analyzed and complete physical examination was performed.
Results: In the period of study 384 patients were in control in the unit. Fifty had ARP which is a prevalence of 13%. Anal condyloma disease and hemorrhoidal disease were the most common diseases. Most patients (76%) were on antiretroviral therapy with good clinical response.
Conclusion: The prevalence of ARP in HIV/AIDS patient has increased in recent years. This study shows a change in the pattern of presentation, being anal condyloma the most common ARP.
AIDS. 2012 May 15;26(8):1035-6.
HIV protease inhibitors to prevent progression of cervical intraepithelial neoplasia to cervical cancer: therapeutic opportunities and challenges.
University of California San Francisco, San Francisco, California.
West J Nurs Res. 2012 May 6. [Epub ahead of print]
Dalmida SG, Holstad MM, Diiorio C, Laderman G.
The purpose of this qualitative study was to explore the meaning and use of spirituality among African American (AA), predominantly Christian women with HIV. A nonrandom sample of 20 AA women from a large infectious disease clinic in Metro-Atlanta participated in the study. The study used focus groups and individual interviews to interview women about their lived spiritual experience. Content analysis and NUDIST software were used to analyze transcripts. The findings revealed the spiritual views and practices of AA women with HIV. The following themes (and subthemes) emerged: Spirituality is a process/journey or connection (connection to God, higher power, or spirit and HIV brought me closer to God), spiritual expression (religion/church attendance, prayer, helping others, having faith), and spiritual benefits (health/healing, spiritual support, inner peace/strength/ability to keep going, and here for a reason or purpose/a second chance). Findings highlight the importance of spirituality in health and well-being among AA women with HIV/AIDS.
J Int Assoc Physicians AIDS Care (Chic). 2012 May 7. [Epub ahead of print]
Provider and Patient Correlates of Provider Decisions to Recommend HCV Treatment to HIV Co-Infected Patients.
Wagner G, Osilla KC, Garnett J, Ghosh-Dastidar B, Bhatti L, Witt M, Goetz MB.
RAND Corporation, Santa Monica, CA.
Despite low uptake of hepatitis C virus (HCV) treatment among HIV co-infected patients, few studies have examined the factors that contribute to provider decisions to recommend treatment. Surveys of 173 co-infected patients and their primary care providers, as well as patient chart data, were collected at 3 HIV clinics in Los Angeles; 73% of the patients had any history of being recommended HCV treatment. Multivariate predictors of being offered treatment included being Caucasian, greater HCV knowledge, receiving depression treatment if depressed, and one’s provider having a lower weekly patient load and more years working at the study site. These findings suggest that provider decisions to recommend HCV treatment are influenced by patient factors including race and psychosocial treatment readiness, as well as characteristics of their own practice and treatment philosophy. With changes to HCV treatment soon to emerge, further evaluation of factors influencing treatment decisions is needed to improve HCV treatment uptake.
BMC Health Serv Res. 2012 May 7;12(1):112.
HIV/aids related home based care practices among primary health care workers in Ogun state, Nigeria.
Amoran Olorunfemi E, Ogunsola Elijah O, Salako Albert O and Alausa Ok O
BACKGROUND: HIV/AIDS is fast becoming a chronic disease with the advent of antiretroviral drugs, therefore making home based care key in the management of chronically ill HIV/AIDS patient. The objective of this study was to determine the perception and practice of health care workers on HIV/AIDS related home based care in the health facilities in Ogun state, Nigeria.
METHODS: This study is an analytical cross-sectional study. A multistage cluster sampling technique was used to obtain a representative sample of the primary health care workers in Ogun state. An interviewer administered structured questionnaire was administered by trained health workers to elicit the required information.
RESULTS: A total of 350 health care workers were interviewed, 70% of the respondents could adequately describe the components of home based care. Only 38.7% were aware of the National guideline on home based care practices and 17.1% believe that home based care will not significantly improve the prognosis of PLWAs. Few 19.1% had ever been trained or ever involved 16.6% in home based care practices. Only 20 [5.7%] are involved on a weekly basis, 16 [4.6%] monthly and 22 [6.3%] quarterly. Reasons given for non implementation of home based care are inadequate number of healthcare workers 45%, lack of political will 24.4%, lack of implementation by facility managers 14% and inadequate funds 16.6%. Factors that were significantly associated with the practice of home based care were perception of its relevance in improving prognosis [OR = 54.21, C.I = 23.22-129.52] and presence of a support group in the facility [OR = 4.80, C.I = 2.40-9.57]. There was however no statistically significant relationship between adequate knowledge of home based care [OR = 0.78, C.I = 0.39-1.54] and previous training on home based care (OR = 1.43, C.I = 0.66- 3.06].
CONCLUSION: The practice of home based care for HIV/AIDS among the study population is low and it is greatly influenced by perception of its effectiveness and relevance. The study recommends that the health care workers should be adequately educated on the importance of home based care in the management of chronic illnesses in order to enhance its practice.
J Assoc Nurses AIDS Care. 2012 May 5. [Epub ahead of print]
Training Multidisciplinary Teams to Deliver High-Quality HIV Care to Families in Resource-Limited Settings: The MTCT-Plus Initiative Experience.
Toro PL, Rabkin M, Flam R, El-Sadr W, Donahue M, Chadwick E, Abrams EJ.
The scarcity of trained clinicians is a significant barrier to the delivery of HIV services in resource-limited settings (RLSs) ( [Kuehn, 2007], [Marchal et al., 2005] and [Schneider et al., 2006]). There are marked shortages of physicians and nurses in the countries with the highest HIV prevalence (Cohen et al., 2004), and there is evidence that the shortage of nurses in particular has a deleterious effect on maternal health (Gerein, Green, & Pearson, 2006). In addition to the absolute scarcity of human resources for health, the fact that HIV is a relatively new health challenge means that few clinicians were taught to provide HIV prevention, care, and treatment services during pre-service or in-service trainings (Rabkin, El-Sadr, Mugyenyi, Ramatlapeng, & De Cock, 2010). In response, the President’s Emergency Plan for AIDS Relief (PEPFAR) intends to train and retain more than 140,000 new health care workers by 2014 (PEPFAR, 2011). Additionally, national training curricula have been developed in many countries, as have other in-service training programs.
While national training curricula have the advantage of standardization and the authority of national guidelines, in their early years most employed didactic methods delivered off-site, rarely addressed continuity of care, and did not adequately provide the critical problem-solving skills needed to initiate comprehensive HIV care ( [Cohen et al., 2004], [International Training and Education for Health, 2010], [Marchal et al., 2005], [Schneider et al., 2006] and [Wester et al., 2005]). Moreover, disciplines are generally taught separately and not as part of a cohesive team.
In this article, we describe the training approach taken by Columbia University’s MTCT-Plus Initiative, a multicountry HIV care and treatment program. The Initiative delivered comprehensive health services and antiretroviral treatment (ART) to pregnant and postpartum women, their children, and their families in Côte d’Ivoire, Cameroon, Mozambique, Kenya, Rwanda, Uganda, Zambia, South Africa, and Thailand ( [International Center for AIDS Care and Treatment Programs, 2011] and [Myer et al., 2005]). Comprehensive health services included addressing the multiple needs of families, including psychosocial needs, adherence to care and treatment, disclosure, nutritional, and economic issues, as well as linking families to local community resources as appropriate.
J Infect Dis. 2012 May 4. [Epub ahead of print]
Extended follow-up confirms early vaccine-enhanced risk of HIV acquisition and demonstrates waning effect over time among participants in a randomized trial of recombinant adenovirus HIV vaccine (Step study).
Duerr A, Huang Y, Buchbinder S, Coombs RW, Sanchez J, Del Rio C, Casapia M, Santiago S, Gilbert P, Corey L, Robertson MN; for the Step/ HVTN 504 study team.
Fred Hutchinson Cancer Research Center, Seattle, WA.
Background: The Step study tested whether an adenovirus serotype 5 (Ad5)-vectored HIV vaccine could prevent HIV acquisition and/or reduce viral load set-point after infection. At the first interim analysis non-efficacy criteria were met. Vaccinations were halted; participants were unblinded. In post-hoc analyses, more HIV infections occurred in vaccinees vs. placebo (V: P) recipients in men who had Ad5 neutralizing antibodies and/or were uncircumcised. Follow-up was extended to assess relative risk of HIV acquisition (V: P) over time.
Methods: We used cox proportional hazard models for analyses of vaccine effect on HIV acquisition and analysis of vaccine effect modifiers, and non-parametric and semi-parametric methods for analysis of constancy of relative risk over time.Findings172 of 1836 men were infected. The adjusted V: P hazard ratio (HR) for all follow-up time was 1·40 (95% CI [1·03, 1·92], p=0·03). Vaccine effect differed by baseline Ad5 or circumcision status during first 18 months, but neither was significant for all follow-up time. HR among uncircumcised and/or Ad5 seropositive men waned with time since vaccination. No significant vaccine-associated risk was seen among circumcised, Ad5-negative men (HR = 0·97, p=1·0) over all follow-up time.
Interpretation: The vaccine-associated risk seen in interim analysis was confirmed but waned with time from vaccination.
Bull Math Biol. 2012 May 5. [Epub ahead of print]
Forde J, Volpe JM, Ciupe SM.
Department of Mathematics and Computer Science, Hobart and Williams Smith Colleges, Geneva, NY, email@example.com.
While antiretroviral drugs can drive HIV to undetectably low levels in the blood, eradication is hindered by the persistence of long-lived, latently infected memory CD4 T cells. Immune activation therapy aims to eliminate this latent reservoir by reactivating these memory cells, exposing them to removal by the immune system and the cytotoxic effects of active infection. In this paper, we develop a mathematical model that investigates the use of immune activation strategies while limiting virus and latent class rebound. Our model considers infection of two memory classes, central and transitional CD4 T cells and the role that general immune activation therapy has on their elimination. Further, we incorporate ways to control viral rebound by blocking activated cell proliferation through anti proliferation therapy. Using the model, we provide insight into the control of latent infection and subsequently into the long term control of HIV infection.
Curr Opin Infect Dis. 2012 Jun;25(3):312-20.
Martin-Blondel G, Mars LT, Liblau RS.
Department of Infectious and Tropical Diseases, Toulouse University Hospital; UMR Inserm, U1043; UMR CNRS, U5282; Université de Toulouse, UPS, Centre de Physiopathologie de Toulouse-Purpan, Toulouse, France; Neuro-Immunology Division, Institute of Experimental Immunology, University of Zurich, Switzerland.
PURPOSE OF REVIEW: The immune reconstitution inflammatory syndrome (IRIS) is an important clinical complication in HIV-infected patients initiating antiretroviral therapy. This review focuses on the latest literature pertaining to the pathogenesis of IRIS.
RECENT FINDINGS: The clinical manifestations of IRIS are heterogeneous due to the variety of opportunistic infections that are associated with this inflammatory syndrome. However, the disproportionate inflammation is a defining hallmark for which common mechanisms are suspected. Lymphopenia-induced proliferation in the context of systemic immune activation, presence of high antigenic exposure and a wider availability of interleukin-7 contribute to the exacerbated immune response underlying IRIS. Defect in pathogen clearance by phagocytes might favor high pathogen burden, which in turn is thought to activate both innate immune cells and pathogen-specific T cells upon correction of the CD4 T-cell lymphopenia, predisposing to IRIS. This common scenario might be further invigorated by functional impairments among regulatory T cells.
SUMMARY: Further insight into the cellular mechanisms driving IRIS is urgently needed. Understanding the relative contribution of distinct effector and regulatory T-cell subsets, and innate immune components to IRIS is required to inspire future therapeutic approaches.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012 Mar;37(3):305-10.
Maggie Z, He G, Wang H.
School of Nursing, Central South University, Changsha, China.
The purpose of the review was to explore the effects of nutritional supplements in children with HIV/AIDS. Nutritional supplements were found to have both positive and negative effects in HIV/ AIDS children. It was found that selenium helps to boost immunity. Vitamin D supplementation was found to delay mother to child transmission (MTCT) of HIV and to reduce stunted growth associated with persistent diarrhea. Vitamins B, C, and E were found to delay HIV disease progression, reduce oxidative stress and HIV viral load. Multivitamin supplementation was found to be more effective in delaying HIV disease progression. Protein nutrition was found to improve cognitive and motor developments of children as well as helping HIV-positive children achieve 100% weight for height. Some nutrient supplements, however, were found to have negative effects on HIV/AIDS children. Vitamin A was found to double the risk of mortality of HIV/AIDS in infants exposed to HIV via breastfeeding. Zinc was found to have a positive effect on production of infectious virus through its action on reverse transcriptase. Some micronutrional interact with each other leading to harmful side effects such as diarrhea. Some nutritional supplements interact with antiretroviral drugs leading to treatment failure. It is important for children to be given right doses of nutritional supplements and that their immune system should be closely monitored.
Eur J Prev Cardiol. 2012 May 3. [Epub ahead of print]
Maniar A, Ellis C, Asmuth D, Pollard R, Rutledge J.
Department of Medicine, University of California Davis.
As the population of people living with HIV ages, atherosclerotic cardiovascular disease (ASCVD) has become an increasing cause of morbidity and mortality. Traditional cardiovascular risk factors are common among those with HIV. In addition, some antiretroviral therapy (ART) regimens contribute to conditions such as hyperlipidemia and insulin resistance. However, inflammation is increasingly recognized as a key contributor to ASCVD. HIV infection induces immune activation and inflammation through several mechanisms. Co-infections such as hepatitis C and cytomegalovirus along with HIV itself likely initiate immune activation and inflammation. Translocation of bacterial products across a compromised epithelial barrier as a result of HIV infection is another mechanism by which the immune system is activated. In this article we summarize the current understanding of drivers of immune activation and inflammation among those with HIV and the contribution of each to ASCVD.
Blood Press. 2012 May 8. [Epub ahead of print]
Hypertension and antihypertensive treatment in HIV-infected individuals. A longitudinal cohort study.
Manner IW, Baekken M, Oektedalen O, Os I.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
Objectives. Hypertension is a significant contributor to cardiovascular disease in HIV-infected individuals. The purposes of this study were to assess the development of new-onset hypertension and the use of antihypertensive treatment and blood pressure (BP) control.
Methods. In a longitudinal study of 434 HIV-infected individuals (43±11 years, 72% males, follow-up 3.4±0.8 years), standardized BP recordings were undertaken at three clinical visits both at baseline and at follow-up, and cardiovascular risk factors were monitored. Adjusted odds ratio (OR) for new-onset hypertension (systolic BP≥140 and/or diastolic BP≥90 mmHg or initiation of antihypertensive treatment) was calculated using multiple logistic regression analyses.
Results. New-onset hypertension occurred with an incidence of 29.8 per 1000 person-years (95% CI 20.3-42.2). HIV duration (OR=1.10, 95% CI 1.01-1.20), mean BP (1.24, 95% CI 1.13-1.35) and abnormal urinary albumin excretion (OR=5.47, 95% CI 1.07-27.85) were independent predictors for new-onset hypertension after adjustment. Use of antihypertensive treatment increased threefold from 17% to 49% in hypertensive patients. Adequate BP control was obtained in 22% of patients on antihypertensive therapy.
Conclusions. HIV duration predicted new-onset hypertension, which could suggest involvement of low-grade inflammation; this hypothesis needs to be further explored. Despite increased use of antihypertensive treatment, enhanced awareness and adequate treatment of hypertension are still warranted in HIV-infected individuals.
PLoS One. 2012;7(4):e35906. Epub 2012 Apr 27.
Lignosulfonic Acid Exhibits Broadly Anti-HIV-1 Activity – Potential as a Microbicide Candidate for the Prevention of HIV-1 Sexual Transmission.
Qiu M, Wang Q, Chu Y, Yuan Z, Song H, Chen Z, Wu Z.
Center for Public Health Research, School of Medicine, Nanjing University, Nanjing, People’s Republic of China.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0035906
Some secondary metabolites from plants show to have potent inhibitory activities against microbial pathogens, such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), Treponema pallidum, Neisseria gonorrhoeae, etc. Here we report that lignosulfonic acid (LSA), a polymeric lignin derivative, exhibits potent and broad activity against HIV-1 isolates of diverse subtypes including two North America strains and a number of Chinese clinical isolates values ranging from 21.4 to 633 nM. Distinct from other polyanions, LSA functions as an entry inhibitor with multiple targets on viral gp120 as well as on host receptor CD4 and co-receptors CCR5/CXCR4. LSA blocks viral entry as determined by time-of-drug addiction and cell-cell fusion assays. Moreover, LSA inhibits CD4-gp120 interaction by blocking the binding of antibodies specific for CD4-binding sites (CD4bs) and for the V3 loop of gp120. Similarly, LSA interacts with CCR5 and CXCR4 via its inhibition of specific anti-CCR5 and anti-CXCR4 antibodies, respectively. Interestingly, the combination of LSA with AZT and Nevirapine exhibits synergism in viral inhibition. For the purpose of microbicide development, LSA displays low in vitro cytotoxicity to human genital tract epithelial cells, does not stimulate NF-κB activation and has no significant up-regulation of IL-1α/β and IL-8 as compared with N-9. Lastly, LSA shows no adverse effect on the epithelial integrity and the junctional protein expression. Taken together, our findings suggest that LSA can be a potential candidate for tropical microbicide.
Cold Spring Harb Perspect Med. 2012 May;2(5):a006940.
Malim MH, Bieniasz PD.
Department of Infectious Diseases, King’s College London School of Medicine, Guy’s Hospital, London Bridge, London, United Kingdom.
Retroviruses have long been a fertile model for discovering host-pathogen interactions and their associated biological principles and processes. These advances have not only informed fundamental concepts of viral replication and pathogenesis but have also provided novel insights into host cell biology. This is illustrated by the recent descriptions of host-encoded restriction factors that can serve as effective inhibitors of retroviral replication. Here, we review our understanding of the three restriction factors that have been widely shown to be potent inhibitors of HIV-1: namely, APOBEC3G, TRIM5α, and tetherin. In each case, we discuss how these unrelated proteins were identified, the mechanisms by which they inhibit replication, the means used by HIV-1 to evade their action, and their potential contributions to viral pathogenesis as well as inter- and intraspecies transmission.
3 May 2012
Cape Town — The debate within the global health community about the impact of dedicated HIV/Aids funding on general public health services has been taken a step further with a study showing that funding dedicated to HIV/Aids does not undermine health funding for other diseases.
A six-year long study in Rwanda published in the May 2012 issue of the American Journal of Tropical Medicine and Hygiene, found that when rural health clinics expanded Aids services, these efforts had no adverse effects on other types of health care.
The study’s lead author, Donald S. Shepard – a professor at Brandeis University’s Schneider Institute for Health Policy – added that there was “even evidence that clinics that have received funding for HIV/Aids services provide better care for all patients, including superior prevention services, than do clinics without Aids programmes.”
The team undertook the study in order to address a long-standing debate within the public health community on whether HIV/Aids funding had strengthened or diminished the capacity of health care systems of the recipient countries to manage other diseases…
The additional funding given to those clinics offering Aids treatment also helped “attract patients who could be told about prevention,” said Shepard, and enabled clinic staff to have more encounters with children who might otherwise miss their vaccinations.
The study argues that the findings from Rwanda are born out in other countries such as Ethiopia, where even though there was an influx of funding for HIV/Aids which might have encouraged health professionals to move from the public sector to donor-funded programmes, there was no evidence that this had had a negative effect on the health system overall.
The evidence from Ethiopia showed that “mortality decreased, coverage of immunization increased and antenatal care coverage increased over the four-year period of HIV expansion.”…
DATE: 27 March 2012
A new survey of commercial sex work in Kenya, the first to include male sex workers, has revealed that 40 percent of female and male commercial sex workers are in marriages or stable unions. According to the survey by the National AIDS and Sexually Transmitted Infections Control Programme (NASCOP), the World Bank, Kenya Prisons and Canada’s University of Manitoba, there are an estimated 200,000 commercial sex workers in Kenya, 15,000 of whom are men. The study, which covered all the country’s urban areas with the exception of North Eastern Province, found that Rift Valley and Nairobi provinces had the biggest number of sex workers. ” majority of the male commercial sex workers have sex with men, and this puts them at greater risk because anal sex, as is already known, is a catalyst for the spread of HIV, and because of the stigma involved, many do not seek services like HIV testing,” said Nicholas Muraguri, head of NASCOP… “Their spouses or girlfriends or boyfriends do n ot know they are engaged in commercial sex work, which puts marriages and stable unions at even greater risk of HIV,” he pointed out…
Gonorrhea, once a minor illness, is developing resistance to the last category of drugs that still works against it and could become
By Maryn McKenna | Friday, May 4, 2012 | 1
…A New England Journal of Medicine editorial published in February said the occurrence of that partial resistance increased 17 times between 2006 and 2011. “The threat of untreatable gonorrhea is emerging rapidly,” the editorial warned.
That threat is troubling for two reasons. First, gonorrhea is abundant: it is the second-most reported infectious disease in the U.S., with more than 600,000 new cases a year. Second, if untreated, it can cause widespread organ damage, pelvic inflammatory disease and infertility. Making matter worse, our current methods for tracking and controlling gonorrhea are actually contributing to the spread of resistant disease.
A Slow But Steady Spread
Gonorrhea is the first of the major sexually transmitted diseases (STDs) to tiptoe to the threshold of untreatability. True, chlamydia, which infects 426 of every 100,000 people in the country every year, is more common, and cases of syphilis, which doubled in incidence between 2000 and 2010, are growing faster. But syphilis infects only 4.5 of every 100,000 people, and neither chlamydia nor syphilis has developed significant resistance to antibiotics.
Although Latinos represent just 14 percent of the U.S. population, they account for 17 percent of diagnosed HIV/AIDS cases and nearly one in four Ryan White HIV/AIDS Program clients. HRSA/HAB has recently completed a study of 10 HIV services providers treating predominantly Latino(a)/Hispanic clients. The resulting research report, Responding to the HIV/AIDS Epidemic Among Latinos: Latino Best Practices, provides an outline of effective approaches to addressing barriers to care experienced by Latinos throughout the United States. This issue of HRSA CAREAction summarizes the findings presented in the HRSA/HAB study.View this issue.
The Division of HIV/AIDS Prevention recently released its inaugural annual report, Accelerating Progress, Investing for Impact. This report provides an overview of some of the HIV prevention activities conducted and supported by the Centers for Disease Control and Prevention during late 2010 to the end of 2011.
HIV Mother-to-Child Transmission: Time for Worldwide Elimination Call for Papers HIV mother-to-child transmission (MTCT) has been virtually eliminated in most industrialized countries due to interventions during pregnancy, labor, delivery, infancy, and in the preconception period. Yet worldwide elimination of MTCT remains elusive; hundreds of thousands of new infections and deaths among both HIV-infected and uninfected perinatally exposed children continue to occur annually. Eliminating HIV MTCT is technically possible. We are particularly interested in manuscripts that report innovative steps to overcome the obstacles that remain to MTCT elimination, especially in low- and middle-income countries. Manuscripts that summarize the results of clinical trials or other evaluations of interventions that have reduced MTCT are welcome. Papers that describe strategies for increasing access to the most effective MTCT strategies for underserved populations are of particular interest. Potential topics include, but are not limited to:Use of antiretrovirals, including highly active antiretroviral therapy, during pregnancy, delivery, infancy for prevention of MTCTUse of caesarean delivery for prevention of MTCTReduction of risk related to exclusive artificial infant feeding for perinatally exposed infants in low- and middle-income settings. Reduction of risk related to breast feeding for perinatally exposed infants in low- and middle-income settings. Reduction of unwanted pregnancies in women living with HIVPreconception care for women living with HIV and female uninfected partners of HIV-infected men. Behavioral, structural, and other interventions to increase uptake and adherence to effective MTCT prevention strategies among healthcare providers and women and men of reproductive potentialBefore submission authors should carefully read over the journal’s Author Guidelines, which are located at http://www.hindawi.com/journals/idog/guidelines/ . Prospective authors should submit an electronic copy of their complete manuscript through the journal Manuscript Tracking System at http://mts.hindawi.com/ according to the following timetable:
Manuscript DueFriday, 6 July 2012First Round of ReviewsFriday, 28 September 2012Publication DateFriday, 23 November 2012
Lead Guest Editor: Consuelo Beck Sague, Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
Guest Editors Robert M. Malow, Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL,
Jean R. Anderson, Department of Gynecology and Obstetrics, The Johns Hopkins School of Medicine, Baltimore, MD, USA
Carmen Zorrilla, Maternal Infant Studies Center, University of Puerto Rico, San Juan,PR, USA
Steven Nesheim, Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, USA