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60. Human Immunodeficiency Virus Type 1 (HIV-1) Transactivator of Transcription through Its Intact Core and Cysteine-Rich Domains Inhibits Wnt/β-Catenin Signaling in Astrocytes: Relevance to HIV Neuropathogenesis.
Misc- Policy, Reviews/MetaAnalyses, Structural/Scale-up/Country Level, RCT-Intervention, Economic/Health Disparities/Soc.Justice/Human Rights Issues
Acad Psychiatry. 2012 Nov 1;36(6):479-86. doi: 10.1176/appi.ap.12020034.
Cohen MA, Forstein M.
No abstract…intro excerpt below
AIDS psychiatry has been described as a paradigm for teaching psychosomatic medicine with a biopsychosocial approach (1–7). The need for HIV/AIDS education has been emphasized in descriptions, studies, and surveys of psychiatric residency training programs (3–6). HIV/AIDS psychiatry provides opportunities for psychiatry residents to learn about preventing illness and managing chronic and acute illness in persons with psychiatric disorders. It magnifies the significance of assessing acute mental status changes in medically ill persons, discussing sexual and drug-use behaviors, and integrating a cognitive assessment into every psychiatric consultation. The complexities of AIDS and its treatments also magnify the complicated interactions of medications as influenced by mechanisms of drug metabolism and the necessity for building rapport to facilitate the recognition and management of psychiatric symptoms and disorders that affect adherence to medication and participation in treatment. HIV/AIDS complexities also substantiate the value of integrating palliative approaches to care throughout the course of illness, not only at the end of life.
AIDS is similar to most other complex and severe medical illnesses, such as cancer, cardiovascular illnesses diabetes mellitus, emphysema, and systemic lupus erythematosis. Severe, complex illnesses have a profound impact on the lives of individuals, their loved ones, and families. Nonadherence to medical care heightens suffering, morbidity, and mortality. Most persons with severe, complex illnesses can benefit from a comprehensive, compassionate, biopsychosocial approach to care. Integrating medical and psychiatric care for persons with HIV and AIDS can improve adherence, ameliorate suffering, and decrease morbidity and mortality. AIDS differs from many other complex and severe illnesses because it leads to other multi-morbid and debilitating medical illnesses, such as endocrine, hematologic, renal, pulmonary, neoplastic, and cardiac illness, as well as concomitant illnesses, such as hepatitis C (HCV). AIDS is also associated with specific psychiatric disorders, such as mood disorders, anxiety disorders, psychosis, and HIV-associated neurocognitive disorders (HAND). AIDS differs from many complex and severe illnesses in two ways that are very relevant to HIV/AIDS education. The first is that it is an unusual illness because it is almost entirely preventable, and adherence to risk-reduction behaviors has public health implications. The second is that HIV and AIDS are associated with sex, drug use, and AIDS-associated stigma and discrimination, or AIDSism (8).
Whereas nonadherence to prevention and treatment of all illnesses has tragic consequences to patients, families, and loved ones, nonadherence to prevention and treatment of HIV and AIDS also results in HIV transmission and has significant public health implications. The most significant challenges to AIDS education in psychiatric residency training include illness-related and training-related factors. Illness-related challenges include an illness with rapidly-changing prevalence, incidence, and treatments, as well as stigma and AIDSism. Training-related factors include pressures of time and productivity, as well as complacency and denial regarding HIV and AIDS. During 4 years of training, psychiatry residents rotate through the inpatient and outpatient units of psychiatry and general care, the emergency room, and intensive care units. Each of these settings provides an opportunity for HIV training. In this article, we document the relevance of AIDS education for psychiatry residents and describe an HIV and AIDS curriculum that can be incorporated into 4 years of psychiatric residency to meet these challenges with a systematic and dynamic biopsychosocial approach.
Am J Public Health. 2012 Nov 15. [Epub ahead of print]
Mahle Gray K, Tang T, Shouse L, Li J, Mermin J, Hall HI.
Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; ICF International, Atlanta, GA.
Objectives. To report on indicators of the National HIV/AIDS Strategy, we analyzed data collected through the national HIV surveillance system.
Methods. We analyzed data from adults and adolescents aged 13 years or older diagnosed with HIV in 13 US jurisdictions that have laboratory reporting of CD4+ T-lymphocyte (CD4) and viral load (VL) test results and enter CD4 and VL test results into the national surveillance system.
Results. Of 4899 people diagnosed in 2009, 81.7% had at least 1 CD4 or VL test performed within 3 months of diagnosis. A higher proportion of Whites (86.2%) than Blacks (78.4%) and Hispanics (82.6%) had a CD4 or VL test. Of people who had a VL test, 69.4% had a most recent VL of 200 copies per milliliter or less. The proportion of people with suppressed VLs differed among Blacks (60.2%), Hispanics (70.3%), and Whites (77.4%) and among people aged 13 to 24 years (44.3%) compared with people aged 65 years or older (84.2%). Of men who have sex with men, 74.2% had a suppressed VL.
Conclusions. The findings highlight disparities in access to and success of care.
Rehabil Psychol. 2012 Nov 12. [Epub ahead of print]
Martin DJ, Chernoff RA, Buitron M, Comulada WS, Liang LJ, Wong FL.
Objective: New treatments introduced in the mid-1990s led many people with HIV/AIDS who previously had been disabled by their disease to contemplate workforce reentry; many remain unemployed, and little is known concerning interventions that might help them return to work. We report the results of a randomized clinical trial of an intervention designed to help people with HIV/AIDS reenter the workforce.
Design: We tested a mixed (group-individual) modality intervention that incorporated elements of Motivational Interviewing (Miller & Rollnick, 2002), skills building from Dialectical Behavior Therapy (Linehan, 1993), and job-related skills (Price & Vinokur, 1995). A total of 174 individuals participated in either the intervention or in standard of care and were followed for 24 months.
Results: Compared with individuals referred for standard of care, participants in the intervention engaged in more workforce-reentry activities over time and, once employed, were more likely to remain employed. Dose-response analyses revealed that among intervention participants, participants who attended more than 1 individual session engaged in more workforce-reentry activities than individuals who attended 1 or fewer individual sessions, whereas frequency of group session participation did not effect a difference between participants who attended more than 6 group sessions and participants who attended 6 or fewer group sessions.
Conclusion: Theoretically based workforce-reentry assistance programs can assist disabled people with HIV/AIDS in their return-to-work efforts.
J Gen Intern Med. 2012 Nov 14. [Epub ahead of print]
Driver TH, Terrault N, Saxena V.
School of Medicine, University of California, San Francisco, San Francisco, CA.
With the decrease in transmission via transfusions and injection drug use, acute symptomatic hepatitis C is infrequently seen in developed countries. We report a case of a human immunodeficiency virus (HIV)-infected adult who presented with abdominal pain. His alanine aminotransferase was greater than sixty times the upper limit of normal without any evidence on examination of fulminant hepatic failure. His workup revealed an elevated hepatitis C viral level with a negative hepatitis C antibody. He was discharged once his liver function tests improved. As an outpatient, he had a recurrent bout of symptoms with an elevation of his alanine aminotransferase and hepatitis C viral levels that promoted anti-hepatitis C virus treatment. This case illustrates the importance of considering acute hepatitis C as a cause of acute hepatitis in HIV-infected men who have sex with men. While patients with acute symptomatic hepatitis C generally have a higher rate of spontaneous viral clearance compared to those with an insidious acute infection, most still progress to chronic hepatitis C infection, and patients with HIV coinfection carry a higher risk of progression to chronic disease.
BMC Public Health. 2012 Nov 13;12(1):973. [Epub ahead of print]
Study protocol for the Integra Initiative to assess the benefits and costs of integrating sexual and reproductive health and HIV services in Kenya and Swaziland.
Warren CE, Mayhew SH, Vassall A, Kimani JK, Church K, Obure CD, du-Preez NF, Abuya T, Mutemwa R, Colombini M, Birdthistle I, Askew I, Watts C.
Abstract/Link to free PDF: http://www.biomedcentral.com/1471-2458/12/973/abstract
BACKGROUND: In sub-Saharan Africa (SSA) there are strong arguments for the provision of integrated sexual and reproductive health (SRH) and HIV services. Most HIV transmissions are sexually transmitted or associated with pregnancy, childbirth, and breastfeeding. Many of the behaviours that prevent HIV transmission also prevent sexually transmitted infections and unintended pregnancies. There is potential for integration to increase the coverage of HIV services, as individuals who use SRH services can benefit from HIV services and vice-versa, as well as increase cost-savings. However, there is a dearth of empirical evidence on effective models for integrating HIV/SRH services. The need for robust evidence led a consortium of three organizations — International Planned Parenthood Federation, Population Council and the London School of Hygiene & Tropical Medicine — to design/implement the Integra Initiative. Integra seeks to generate rigorous evidence on the feasibility, effectiveness, cost and impact of different models for delivering integrated HIV/SRH services in high and medium HIV prevalence settings in SSA.
METHODS/DESIGN: A quasi-experimental study will be conducted in government clinics in Kenya and Swaziland — assigned into intervention/comparison groups. Two models of service delivery are investigated: integrating HIV care/treatment into 1) family planning and 2) postnatal care. A full economic-costing will be used to assess the costs of different components of service provision, and the determinants of variations in unit costs across facilities/service models. Health facility assessments will be conducted at four time-periods to track changes in quality of care and utilization over time. A two-year cohort study of family planning/postnatal clients will assess the effect of integration on individual outcomes, including use of SRH services, HIV status (known/unknown) and pregnancy (planned/unintended). Household surveys within some of the study facilities’ catchment areas will be conducted to profile users/non-users of integrated services and demand/receipt of integrated services, before-and-after the intervention. Qualitative research will be conducted to complement the quantitative component at different time points. Integra takes an embedded ‘programme science’ approach to maximize the uptake of findings into policy/practice.
DISCUSSION: Integra addresses existing evidence gaps in the integration evaluation literature, building on the limited evidence from SSA and the expertise of its research partners.
Nat Rev Microbiol. 2012 Dec;10(12):852-67. doi: 10.1038/nrmicro2911.
Hatziioannou T, Evans DT.
Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York. email@example.com.
The AIDS pandemic continues to present us with unique scientific and public health challenges. Although the development of effective antiretroviral therapy has been a major triumph, the emergence of drug resistance requires active management of treatment regimens and the continued development of new antiretroviral drugs. Moreover, despite nearly 30 years of intensive investigation, we still lack the basic scientific knowledge necessary to produce a safe and effective vaccine against HIV-1. Animal models offer obvious advantages in the study of HIV/AIDS, allowing for a more invasive investigation of the disease and for preclinical testing of drugs and vaccines. Advances in humanized mouse models, non-human primate immunogenetics and recombinant challenge viruses have greatly increased the number and sophistication of available mouse and simian models. Understanding the advantages and limitations of each of these models is essential for the design of animal studies to guide the development of vaccines and antiretroviral therapies for the prevention and treatment of HIV-1 infection.
Int J STD AIDS. 2012 Nov;23(11):806-9.
Duncan S, Jones R, McIntyre M, Pilsniak A, Trott J, Desmond N.
The Garden Clinic, Upton Hospital, Albert Street, Slough.
The management of HIV in pregnancy has evolved significantly over the past 10 years as our experience of combination antiretroviral therapy (ART) has grown. We reviewed 109 pregnancies which were managed at our community-based integrated HIV and sexual health clinic to investigate preconception and antenatal care, and trends in ART over time. We document an increasing proportion of pregnancies in which the mother was aware of her HIV status pre-conception and conception on ART. Pre-conception care was sought in a minority of cases, and many women did not present for first antenatal review until the end of the second trimester. Of 108 live births, there was one case of vertical transmission (0.93%). While our study demonstrates the efficacy of current strategies to prevent mother to child transmission of HIV infection, more could be done to encourage HIV-positive women to seek preconception advice and to attend for early review in the first trimester.
Int J STD AIDS. 2012 Nov;23(11):833-4.
Woolley I, Bailey C.
Department of Infectious Diseases, Monash Medical Centre; Department of Medicine, Monash University, Clayton, Victoria, Australia.
We report three cases of immigrants to Australia, living with HIV/AIDS, who, while travelling in countries of origin or migration, were unable to continue to take their antiretrovirals appropriately. We discuss the possible reasons for this and ways to reduce the possibility of it happening. Travel may be a significant risk factor for non-adherence; pre-travel advice and planning might help to prevent it occurring.
BMC Infect Dis. 2012 Nov 15;12(1):304. [Epub ahead of print]
Multivitamin supplementation in HIV infected adults initiating antiretroviral therapy in Uganda: the protocol for a randomized double blinded placebo controlled efficacy trial.
Guwatudde D, Ezeamama AE, Bagenda D, Kyeyune R, Wabwire-Mangen F, Wamani H, Mugusi F, Spiegelman D, Wang M, Manabe YC, Fawzi WW.
Abstract/Link to free PDF: http://www.biomedcentral.com/1471-2334/12/304/abstract
BACKGROUND: Use of multivitamin supplements during the pre-HAART era has been found to reduce viral load, enhance immune response, and generally improve clinical outcomes among HIV-infected adults. However, immune reconstitution is incomplete and significant mortality and opportunistic infections occur in spite of HAART. There is insufficient research information on whether multivitamin supplementation may be beneficial as adjunct therapy for HIV-infected individuals taking HAART. We propose to evaluate the efficacy of a single recommended daily allowance (RDA) of micronutrients (including vitamins B-complex, C, and E) in slowing disease progression among HIV-infected adults receiving HAART in Uganda.
METHODS: We are using a randomized, double-blind, placebo-controlled trial study design. Eligible patients are HIV-positive adults aged at least 18 years, and are randomized to receive either a placebo; or multivitamins that include a single RDA of the following vitamins: 1.4 mg B1, 1.4 mg B2, 1.9 mg B6, 2.6 mcg B12, 18 mg niacin, 70 mg C, 10 mg E, and 0.4 mg folic acid. Participants are followed for up to 18 months with evaluations at baseline, 6, 12 and 18 months. The study is primarily powered to examine the effects on immune reconstitution, weight gain, and quality of life. In addition, we will examine the effects on other secondary outcomes including the risks of development of new or recurrent disease progression event, including all-cause mortality; ARV regimen change from first- to second-line therapy; and other adverse events as indicated by incident peripheral neuropathy, severe anemia, or diarrhea.
DISCUSSIONS: The conduct of this trial provides an opportunity to evaluate the potential benefits of this affordable adjunct therapy (multivitamin supplementation) among HIV-infected adults receiving HAART in a developing country setting.
AIDS Res Hum Retroviruses. 2012 Nov 15. [Epub ahead of print]
Willig JH, Westfall A, Mugavero MJ, Nevin CR, Correll T, Duggal A, Guyer W, Saag M, Juday T.
University of Alabama at Birmingham, Medicine- Infectious Diseases, Birmingham, Alabama; firstname.lastname@example.org.
Introduction: Persistency is the time from initiation to discontinuation of therapy. Previous research has described factors that affect the persistency of initial antiretroviral therapy (ART); however, the impact of persistency on clinical outcomes is unknown.
Methods: Retrospective study of treatment naïve HIV patients initiating ART between 1/1/00 and 12/31/10 at an academic medical center. Descriptive statistics and Cox proportional hazards regression models with persistency as a time-varying covariate were fit for: (1) immunologic failure (subsequent CD4 lower than initial CD4); (2) development of an opportunistic infection (OI) or malignancy; (3) mortality. Analyses were repeated with an interaction term of persistency (per 180 days) and time (before and after 1 year of ART).
Results: Among 879 patients who started ART, mean age was 38 years (±10) and most patients were racial/ethnic minority (59%), males (80%), with baseline CD4<200 cells/mm3 (52%). There were 100 deaths, 94 OIs / malignancy, and 183 immunologic failures; mean persistency = 723 days. In multi-variable modeling, increased persistency decreased the overall and long-term hazard for immunologic failure (0.84 per 180 additional days; 0.70-1.00; 0.045). Increased persistency exhibited a potential trend towards decreased hazard for occurrence of OI/malignancy (0.91; 0.80-1.03; 0.124) overall and after 1 year. Persistency exhibited a trend towards less risk of mortality in the first year of ART (0.42; 0.17-1.06; 0.067).
Discussion: In this study of the relationship between initial ART persistency and clinical outcomes, increased persistency was associated with a decreased hazard for the development of immunologic failure, a trend towards a decreased hazard for OI/malignancy and a trend towards a decreased risk of first year mortality. Given these findings, the relationship between persistency and clinical outcomes merits further study.
AIDS Res Hum Retroviruses. 2012 Nov 14. [Epub ahead of print]
The Effect of a year of Highly Active Antiretroviral Therapy on Immune Reconstruction and Cytokines in HIV/AIDS patients.
He Y, Yao Y, Luo Y, Zheng Y, Zhang Q, Huaying Z, Zeng S, Chen Z, He B, He M.
Central South University, Infectious Disease and AIDS Research Center, Second Xiangya Hospital Central South University Changsha, Changsha, China. email@example.com.
To investigate the effect of a year of HAART on immune reconstruction and cytokine production in HIV/AIDS patients, 35 AIDS patients were recruited for HAART treatment and 35 healthy volunteers were assigned as controls. The dynamic changes in HIV load, blood T cell subset counts as well as IL-12, IFN-γ, and IP-10 levels in AIDS patients were evaluated before HAART and at the 6th and 12th month after therapy. Our results revealed that HIV virus load in HIV/AIDS patients was reduced below the detectable limit after patients received 6 months of HAART. CD3+CD4+, CD4+CD45RA+62L+, and CD4+CD45RO+ T cells were found to be significantly decreased in HIV/AIDS patients compared to the healthy controls, but increased after HAART. CD3+CD8+ and CD8+CD38+ cells were found to be increased in HIV/AIDS patients but decreased after HAART. Plasma IL-12 and IFN-γ levels were lower but IP-10 level was higher in AIDS patients compared to controls. HAART significantly improved IL-12, IFN- γ levels but reduced IP-10 level in AIDS patients (p < 0.01). CD4+CD45RA+62L+ and CD4+CD45RO+ T cells were positively correlated with plasma IL-12/IFN-γ levels (p < 0.05), but negatively correlated with plasma IP-10 level. On the contrary, CD3+CD8+ cells were negatively correlated with plasma IL-12 and IFN-γ levels, but positively correlated with IP-10 level (p < 0.05). HAART benefits HIV/AIDS patients by not only inhibiting virus replication but also contributing to immune reconstruction, such as restoring subsets of T cells and adjusting cytokine production in HIV/AIDS patients.
Pediatr Infect Dis J. 2012 Oct 30. [Epub ahead of print]
Antiretroviral Regimens Containing a Single Protease Inhibitor Increase Risk of Virologic Failure in Young HIV-Infected Children.
Walters E, Reichmuth K, Dramowski A, Marais BJ, Cotton MF, Rabie H.
Stellenbosch University, Cape Town, South Africa; University of Cape Town, South Africa; The Children’s Hospital at Westmead, University of Sydney, Australia.
Rifampin-based tuberculosis (TB) treatment can cause sub-therapeutic concentrations of protease-inhibitors (PI) and virologic failure in children receiving antiretroviral therapy (ART). Among 217 children on ART, TB co-treatment (in 78) was associated with virologic failure. Ritonavir-based single PI ART regimen predicted virologic failure (adjusted odds ratio 3.7, 95% confidence interval 1.5-8.9, p=0.004) on multivariate analysis.
PLoS One. 2012;7(10):e46943. Epub 2012 Oct 24.
Outcomes of Multidrug-Resistant Tuberculosis Treatment with Early Initiation of Antiretroviral Therapy for HIV Co-Infected Patients in Lesotho.
Satti H, McLaughlin MM, Hedt-Gauthier B, Atwood SS, Omotayo DB, Ntlamelle L, Seung KJ.
Partners In Health, Maseru, Lesotho ; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
Free HTML/Link to free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0046943
BACKGROUND: Although the importance of concurrent treatment for multidrug-resistant tuberculosis (MDR-TB) and HIV co-infection has been increasingly recognized, there have been few studies reporting outcomes of MDR-TB and HIV co-treatment. We report final outcomes of comprehensive, integrated MDR-TB and HIV treatment in Lesotho and examine factors associated with death or treatment failure.
METHODS: We reviewed clinical charts of all adult patients who initiated MDR-TB treatment in Lesotho between January 2008 and September 2009. We calculated hazard ratios (HR) and used multivariable Cox proportional hazards regression to identify predictors of poor outcomes.
RESULTS: Of 134 confirmed MDR-TB patients, 83 (62%) were cured or completed treatment, 46 (34%) died, 3 (2%) transferred, 1 (1%) defaulted, and 1 (1%) failed treatment. Treatment outcomes did not differ significantly by HIV status. Among the 94 (70%) patients with HIV co-infection, 53% were already on antiretroviral therapy (ART) before MDR-TB treatment initiation, and 43% started ART a median of 16 days after the start of the MDR-TB regimen. Among HIV co-infected patients who died, those who had not started ART before MDR-TB treatment had a shorter median time to death (80 days vs. 138 days, p = 0.065). In multivariable analysis, predictors of increased hazard of failure or death were low and severely low body mass index (HR 2.75, 95% confidence interval [CI] 1.27-5.93; HR 5.50, 95% CI 2.38-12.69), and a history of working in South Africa (HR 2.37, 95% CI 1.24-4.52).
CONCLUSIONS: Favorable outcomes can be achieved in co-infected patients using a community-based treatment model when both MDR-TB and HIV disease are treated concurrently and treatment is initiated promptly.
Am J Public Health. 2012 Nov 15. [Epub ahead of print]
Individual and Network Factors Associated With Prevalent Hepatitis C Infection Among Rural Appalachian Injection Drug Users.
Havens JR, Lofwall MR, Frost SD, Oser CB, Leukefeld CG, Crosby RA.
University of Kentucky College of Medicine, Lexington; University of Cambridge, Cambridge, UK; University of Kentucky College of Arts and Sciences, Lexington; University of Kentucky College of Public Health, Lexington.
Objectives. We determined the factors associated with hepatitis C (HCV) infection among rural Appalachian drug users.
Methods. This study included 394 injection drug users (IDUs) participating in a study of social networks and infectious disease risk in Appalachian Kentucky. Trained staff conducted HCV, HIV, and herpes simplex-2 virus (HSV-2) testing, and an interviewer-administered questionnaire measured self-reported risk behaviors and sociometric network characteristics.
Results. The prevalence of HCV infection was 54.6% among rural IDUs. Lifetime factors independently associated with HCV infection included HSV-2, injecting for 5 or more years, posttraumatic stress disorder, injection of cocaine, and injection of prescription opioids. Recent (past-6-month) correlates of HCV infection included sharing of syringes (adjusted odds ratio = 2.24; 95% confidence interval = 1.32, 3.82) and greater levels of eigenvector centrality in the drug network.
Conclusions. One factor emerged that was potentially unique to rural IDUs: the association between injection of prescription opioids and HCV infection. Therefore, preventing transition to injection, especially among prescription opioid users, may curb transmission, as will increased access to opioid maintenance treatment, novel treatments for cocaine dependence, and syringe exchange.
Int J STD AIDS. 2012 Nov;23(11):799-805.
Evaluating the implementation of nurse-initiated HIV rapid testing in three Veterans Health Administration substance use disorder clinics.
Conners EE, Hagedorn HJ, Butler JN, Felmet K, Hoang T, Wilson P, Klima G, Sudzina E, Anaya HD.
Veterans Affairs Quality Enhancement Research Initiative (QUERI) for HIV and Hepatitis, VA Greater Los Angeles Healthcare System.
Individuals with substance use disorders (SUDs) are at higher risk of HIV infection, yet recent studies show rates of HIV testing are low among this population. We implemented and evaluated a nurse-initiated HIV oral rapid testing (NRT) strategy at three Veterans Health Administration SUD clinics. Implementation of NRT includes streamlined nurse training and a computerized clinical reminder. The evaluation employed qualitative interviews with staff and a quantitative evaluation of HIV testing rates. Barriers to testing included lack of laboratory support and SUD nursing resistance to performing medical procedures. Facilitators included the ease of NRT integration into workflow, engaged management and an existing culture of disease prevention. Six-months post intervention, rapid testing rates at SUD clinics in sites 1, 2, and 3 were 5.0%, 1.1% and 24.0%, respectively. Findings indicate that NRT can be successfully incorporated into some types of SUD subclinics with minimal perceived impact on workflow and time.
Int J STD AIDS. 2012 Nov;23(11):792-8.
Luu HN, Amirian ES, Beasley RP, Piller L, Chan W, Scheurer ME.
Dan L Duncan Cancer Center, Baylor College of Medicine.
While the association between smoking and human papillomavirus infection, cervical cancer, and anal cancer has been well studied, evidence on the association between cigarette smoking and anal warts is limited. The purpose of this study was to investigate if cigarette smoking status influences the size of anal warts over time in HIV-infected women in a sample of 976 HIV-infected women from the Women’s Interagency HIV Study (WIHS). A linear mixed model was used to determine the effect of smoking on anal wart size. Even though women who were currently smokers had larger anal warts at baseline and slower growth rate of anal wart size after each visit than women who were not current smokers, there was no association between size of anal wart and current smoking status over time. Further studies on the role of smoking and interaction between smoking and other risk factors, however, should be explored.
Front Psychiatry. 2012;3:98. Epub 2012 Nov 12.
Mukku VK, Benson TG, Alam F, Richie WD, Bailey RK.
Department of Psychiatry and Behavioral Sciences, Meharry Medical College School of Medicine Nashville, TN.
Incarceration affects the lives of many African American men and often leads to poverty, ill health, violence, and a decreased quality of life. There has been an unprecedented increase in incarceration among African American males since 1970. In 2009, the incarceration rate among black males was 6.7 times that of white males and 2.6 times of Hispanic males. Substance abuse in African American males leads to higher mortality rates, high rates of alcohol-related problems, more likely to be victims of crimes, and HIV/AIDS. African Americans comprised only 14% of the U.S. population but comprised 38% of the jail population. The cost of incarcerating persons involved in substance related crimes has increased considerably over the past two decades in the U.S. A reduction in the incarceration rate for non-violent offences would save an estimated $17 billion per year. Substance use disorder makes the individual more prone to polysubstance use and leads to impulse control problems, selling drugs, and other crimes. The high rate of incarceration in U.S. may adversely affect health care, the economy of the country, and will become a burden on society. Implementation of good mental health care, treatment of addiction during and after incarceration will help to decrease the chances of reoffending. Therapeutic community programs with prison-based and specialized treatment facilities, cognitive behavioral therapy treatment for 91-180 days, and 12-step orientation with staff specialized in substance abuse can be helpful. It is essential for health care professionals to increase public awareness of substance abuse and find ways to decrease the high rates of incarceration.
J Appl Soc Sci. 2012 Mar;6(1):72-91.
A Contextual Comparison of Risk Behaviors Among Older Adult Drug Users and Harm Reduction in Suburban Versus Inner-City Social Environments.
Boeri MW, Tyndall BD.
Kennesaw State University.
Recent epidemiological data show that older adults comprise a growing age group of drug users and new AIDS cases in the United States. Prevention and intervention studies show that risk behaviors leading to HIV infection are increasing among older users, particularly among the socially vulnerable. Yet older adults remain an under-researched population of drug users and little is known about their risk behaviors. Our aim is to address this gap in knowledge on older users by comparing contextual factors that influence risk behaviors and harm reduction strategies practiced by older drug users living in different communities. This study is based on ethnographic fieldwork in suburban and inner-city neighborhoods in a large metropolitan area in the southeastern USA. Interviewers conducted face-to-face, in-depth, life-history interviews with 69 older adults (age 45 and older) who used heroin, cocaine, and/or methamphetamine. Findings show that while risk behaviors were similar among older adult drug users living in suburban and inner-city environments, the provision of harm reduction education and paraphernalia varied widely. The results show the need for the expansion of harm reduction services focused on older adult drug users who are homeless, uninsured, or socially isolated. This application-oriented research will inform healthcare and treatment providers and generate new directions for future collaborative harm reduction services aimed to decrease the spread of HIV and other infectious diseases associated with drug use.
Subst Abuse Treat Prev Policy. 2012 Nov 16;7(1):46. [Epub ahead of print]
Lund IO, Kirtadze I, Otiashvili D, O Grady KE, Jones HE.
Abstract/Link to free PDF: http://www.substanceabusepolicy.com/content/7/1/46/abstract
BACKGROUND: HIV and Hepatitis C virus (HCV) infections are strongly related to injection drug use in the Republic of Georgia. Little information is available about HIV and HCV status, sexual risk, support for their partner, and risk for physical violence among the female partners of opioid-injecting men in the Republic of Georgia, many of whom may not be using drugs, yet may be at high risk of being infected with HIV and HCV from their drug-using partners.
METHODS: In order to better understand the risks for females whose partners are injecting drugs, the present study conducted an initial investigation of the non-substance-using female partners of 40 opioid-injecting men who were participating in a clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone. The 40 female partners were assessed at their male partners’ study intake.
RESULTS: The female sample was 32.3 years old (SD=6.7), 37 (93%) were married, with 15.5 years of education. A majority reported at least partial employment the majority of the time during the past 3 years, with only one woman reported being unemployed most of the time during the past 3 years. They self-reported they were 3% HIV-positive and 8% HCV-positive. Their HIV sex risk scores indicated a relatively low risk. However, only 4 (10%) women reported using a condom most of the time while having sex and 15 (38%) report not having had sex during the last 30 days. Experiences of interpersonal violence were common, with 42% reporting physical abuse by their partner during the last year and 48% reporting feeling unsafe in their current relationship.
CONCLUSIONS: The alarmingly high rate of failure to use barrier protection methods, together with the high percentage who did not know their HIV and HCV status, suggest that it may be beneficial to include non-substance-using female partners in prevention programs along with their partners to reduce the risk of HIV and HCV spreading from the population of injection-drug–using males into the general population.
PLoS One. 2012;7(11):e49417. Epub 2012 Nov 12.
Bengtsson L, Lu X, Nguyen QC, Camitz M, Hoang NL, Nguyen TA, Liljeros F, Thorson A.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Free HTML/Link to free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0049417
OBJECTIVE: Lack of representative data about hidden groups, like men who have sex with men (MSM), hinders an evidence-based response to the HIV epidemics. Respondent-driven sampling (RDS) was developed to overcome sampling challenges in studies of populations like MSM for which sampling frames are absent. Internet-based RDS (webRDS) can potentially circumvent limitations of the original RDS method. We aimed to implement and evaluate webRDS among a hidden population.
METHODS AND DESIGN: This cross-sectional study took place 18 February to 12 April, 2011 among MSM in Vietnam. Inclusion criteria were men, aged 18 and above, who had ever had sex with another man and were living in Vietnam. Participants were invited by an MSM friend, logged in, and answered a survey. Participants could recruit up to four MSM friends. We evaluated the system by its success in generating sustained recruitment and the degree to which the sample compositions stabilized with increasing sample size.
RESULTS: Twenty starting participants generated 676 participants over 24 recruitment waves. Analyses did not show evidence of bias due to ineligible participation. Estimated mean age was 22 years and 82% came from the two large metropolitan areas. 32 out of 63 provinces were represented. The median number of sexual partners during the last six months was two. The sample composition stabilized well for 16 out of 17 variables.
CONCLUSION: Results indicate that webRDS could be implemented at a low cost among Internet-using MSM in Vietnam. WebRDS may be a promising method for sampling of Internet-using MSM and other hidden groups.
J Public Health Policy. 2012 Nov 15. [Epub ahead of print]
Community-based HIV prevention interventions that combat anti-gay stigma for men who have sex with men and for transgender women.
Cahill S, Valadéz R, Ibarrola S.
The Fenway Institute, Boston, Massachusetts; New York University, Wagner School of Public Service, New York, NY.
Men who have sex with men (MSM) have been disproportionately affected by HIV since the onset of the epidemic. Public health discourse about prevention has traditionally focused on individual risk behavior and less on the socio-structural factors that place MSM at increased risk of infection. Anti-gay bias and stigma are key structural drivers of HIV and must therefore be treated as a public health threat. Community-based prevention intervention programs that affirm the healthy formation of gay and transgender identities are strongly needed. Gay affirming school-based interventions and resiliency-focused social marketing campaigns have shown positive impact on health outcomes and should be implemented on a broader scale to challenge anti-gay stigma.
BMC Public Health. 2012 Nov 14;12(1):978. [Epub ahead of print]
Prevalence of HIV among MSM in Europe: comparison of self-reported diagnoses from a large scale internet survey and existing national estimates.
Marcus U, Hickson F, Weatherburn P, Schmidt AJ.
Abstract/Link to free PDF: http://www.biomedcentral.com/1471-2458/12/978/abstract
BACKGROUND: Country level comparisons of HIV prevalence among men having sex with men (MSM) is challenging for a variety of reasons, including differences in the definition and measurement of the denominator group, recruitment strategies and the HIV detection methods. To assess their comparability, self-reported data on HIV diagnoses in a 2010 pan-European MSM internet survey (EMIS) were compared with pre-existing estimates of HIV prevalence in MSM from a variety of European countries.
METHODS: The first pan-European survey of MSM recruited more than 180,000 men from 38 countries across Europe and included questions on the year and result of last HIV test. HIV prevalence as measured in EMIS was compared with national estimates of HIV prevalence based on studies using biological measurements or modelling approaches to explore the degree of agreement between different methods. Existing estimates were taken from Dublin Declaration Monitoring Reports or UNAIDS country fact sheets, and were verified by contacting the nominated contact points for HIV surveillance in EU/EEA countries.
RESULTS: The EMIS self-reported measurements of HIV prevalence were strongly correlated with existing estimates based on biological measurement and modelling studies using surveillance data (R2=0.70 resp. 0.72). In most countries HIV positive MSM appeared disproportionately likely to participate in EMIS, and prevalences as measured in EMIS are approximately twice the estimates based on existing estimates.
CONCLUSIONS: Comparison of diagnosed HIV prevalence as measured in EMIS with pre-existing estimates based on biological measurements using varied sampling frames (e.g. Respondent Driven Sampling, Time and Location Sampling) demonstrates a high correlation and suggests similar selection biases from both types of studies. For comparison with modelled estimates the self-selection bias of the Internet survey with increased participation of men diagnosed with HIV has to be taken into account. For most countries self-reported EMIS prevalence is higher than measured prevalence, which is likely due to a combination of different time points of measurement, measurement errors for small sample sizes, different sampling methods, and an indicator-inherent overestimate of prevalence among the untested fraction of MSM.
J Infect Dis. 2012 Nov 16. [Epub ahead of print]
HPV genotype attribution and estimation of preventable fraction of anal intraepithelial neoplasia among HIV-infected men who have sex with men.
Sahasrabuddhe VV, Castle PE, Follansbee S, Borgonovo S, Tokugawa D, Schwartz LM, Lorey TS, Lamere BJ, Gage JC, Fetterman B, Boyle S, Sadorra M, Tang SD, Darragh TM, Wentzensen N.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD.
Background. The prevention of human papillomavirus (HPV)-induced anal cancer in high risk populations like human immunodeficiency virus (HIV)-infected MSM remains an urgent priority given rising incidence rates despite widespread antiretroviral therapy use.
Methods. HPV genotypes and anal disease prevalence by cytology and histopathology were evaluated among 363 HIV-infected MSM. We modeled fractions of high-grade anal intraepithelial neoplasia (HGAIN) attributable to individual carcinogenic HPV genotypes and estimated the range of proportion of HGAIN potentially preventable by prophylactic HPV vaccines.
Results. HPV16 was the most common genotype overall (26.4%) and among those with HGAIN (55%). Multiple (2+) carcinogenic HPV genotype prevalence increased from 30.9% in those with <AIN1 to 76.3% in AIN3 (p(trend)<0.001). The fractions of HGAIN attributable to carcinogenic HPV16/18 targeted by licensed bi/quadrivalent HPV vaccines ranged between 12% and 61.5% and the fractions attributable to HPV16/18/31/33/45/52/58 targeted by an investigational nonavalent HPV vaccine ranged between 39% to 89.4%.
Conclusion. Our analytical framework allows estimation of HGAIN attributable to individual HPV genotypes in the context of multiple concurrent HPV infections that are very common among HIV-infected MSM. Our results suggest that licensed and investigational HPV prophylactic vaccines have the potential to prevent a substantial proportion of HGAIN in this population.
Zhonghua Yu Fang Yi Xue Za Zhi. 2012 Aug;46(8):732-5.
[Article in Chinese]
Tan JG, Cheng JQ, Lu ZX.
Social Medicial and Health Management Department, School of Public Health, Tongji Medicine College Huazhong University of Science and Technology, Wuhan, China.
OBJECTIVE: This study aimed to explore and evaluate the effects of combination intervention model conducted by Center for Disease Control and Prevention and activity place to men who have sex with men (MSM).
METHODS: To implement one-year combination intervention in 4 MSM venues during May, 2009 and April, 2010. Meanwhile, 3 similar MSM venues were chosen as control. MSM places introduced CDC to consumption crowds. Experts and volunteers sent by CDC undertook health education programme on site and condom, lubricant, pamphlet, consultation, test were provided at the same time. The intervetion measeures applied to control only included providing pamphlet, condom, lubricant by volunteers. Investigations were conducted among subjects of combination intervetion group and control group before (111, 120 subjects) and after (105, 98 subjects) the intervention with questions related to knowledge and behavior of AIDS prevetion.
RESULTS: After one-year intervetion, among MSM with combination intervetion, the awareness rate of knowledge level about acquired immune deficiency syndrome (AIDS) increased from 73.0% (81/111) to 91.7% (110/120), proportion of condom-use with male at last anal intercourse increased from 73.0% (81/111) to 85.0% (102/120), ratio of never-use condom with male decreased from 10.8% (11/102) to 1.7% (2/112), percentage of acquiring AIDS-related service and intervention improved significantly, acquiring condom (lubricant) increased from 70.3% (78/111) to 85.0% (102/120), acquiring peer education increased from 10.8% (12/111) to 24.2% (29/120), the proportion of acquiring counseling and testing of HIV increased from 69.4% (77/111) to 90.8% (109/120) (all P values < 0.05). The above index show no statistic difference before and after the intervetion (all P values > 0.05) in control MSM venues.
CONCLUSION: Combination intervention model was an effective intervention model contributing to an increase in knowledge of AIDS prevention and decreasing high risk behavior in MSM population.
Hisp Health Care Int. 2012 Jan 3;10(1):42-52.
Applying Ecodevelopmental Theory and the Theory of Reasoned Action to Understand HIV Risk Behaviors Among Hispanic Adolescents.
Ortega J, Huang S, Prado G.
University of Miami, School of Nursing and Health Studies.
HIV/AIDS is listed as one of the top 10 reasons for the death of Hispanics between the ages of 15 and 54 in the United States. This cross sectional, descriptive secondary study proposed that using both the systemic (ecodevelopmental) and the individually focused (theory of reasoned action) theories together would lead to an increased understanding of the risk and protective factors that influence HIV risk behaviors in this population. The sample consisted of 493 Hispanic adolescent 7th and 8th graders and their immigrant parents living in Miami, Florida. Structural Equation Modeling (SEM) was used for the data analysis. Family functioning emerged as the heart of the model, embedded within a web of direct and mediated relationships. The data support the idea that family can play a central role in the prevention of Hispanic adolescents’ risk behaviors.
J Antimicrob Chemother. 2012 Nov 14. [Epub ahead of print]
Pereira R, Cole MJ, Ison CA.
Sexually Transmitted Bacteria Reference Laboratory, Health Protection Agency, London, UK.
OBJECTIVES: Antimicrobial resistance in Neisseria gonorrhoeae is an increasing problem worldwide and combinations of antimicrobial agents have been recommended to delay the onset of treatment failures. The objective of this study was to obtain in vitro data on the activity of current (ceftriaxone or cefixime plus azithromycin) and alternative (gentamicin plus azithromycin) regimens.
METHODS: A panel of 64 gonococcal isolates displaying various cefixime MICs was selected for inclusion in the study. Determination of the activities of the antimicrobial combinations of ceftriaxone, cefixime or gentamicin with azithromycin was performed using the agar dilution method and subsequent calculation of the fractional inhibitory concentration index (FICI) values.
RESULTS: No antagonism for any of the antimicrobial combinations was detected among the 64 gonococcal isolates. When cefixime or ceftriaxone was combined with azithromycin all isolates showed additivity/indifference with a mean FICI of 2.0. All gonococcal isolates also showed additivity/indifference with the antimicrobial combination of gentamicin with azithromycin, but with a lower mean FICI of 1.7. No significant difference in the mean FICI between isolates fully susceptible to cefixime and isolates with decreased susceptibility to cefixime was observed.
CONCLUSIONS: The results obtained support the gonorrhoea treatment currently recommended in the UK national guidelines and suggest that gentamicin with azithromycin could be a future treatment option. The in vivo activity and efficacy of these combinations remain unknown and prospective clinical studies should be addressed.
Postgrad Med J. 2012 Nov 13. [Epub ahead of print]
Darling KE, Gloor E, Ansermet-Pagot A, Vaucher P, Durieux-Paillard S, Bodenmann P, Cavassini M.
Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
OBJECTIVES: Street-based sex workers (SSWs) in Lausanne, Switzerland, are poorly characterised. We set out to quantify potential vulnerability factors in this population and to examine SSW healthcare use and unmet healthcare requirements.
METHODS: We conducted a cross-sectional questionnaire-based survey among SSWs working in Lausanne’s red light district between 1 February and 31 July 2010, examining SSW socio-demographic characteristics and factors related to their healthcare.
RESULTS: We interviewed 50 SSWs (76% of those approached). A fifth conducted their interviews in French, the official language in Lausanne. 48 participants (96%) were migrants, of whom 33/48 (69%) held no residence permit. 22/50 (44%) had been educated beyond obligatory schooling. 28/50 (56%) had no health insurance. 18/50 (36%) had been victims of physical violence. While 36/50 (72%) had seen a doctor during the preceding 12 months, only 15/50 (30%) were aware of a free clinic for individuals without health insurance. Those unaware of free services consulted emergency departments or doctors outside Switzerland. Gynaecology, primary healthcare and dental services were most often listed as needed. Two individuals (of 50, 4%) disclosed positive HIV status; of the others, 24/48 (50%) had never had an HIV test.
CONCLUSIONS: This vulnerable population comprises SSWs who, whether through mobility, insufficient education or language barriers, are unaware of services they are entitled to. With half the participants reporting no HIV testing, there is a need to enhance awareness of available facilities as well as to increase provision and uptake of HIV testing.
Health Psychol. 2012 Nov;31(6):737.
“Whose intentions predict? Power over condom use within heterosexual dyads”: Correction to VanderDrift, Agnew, Harvey, and Warren (2012).
Vanderdrift LE, Agnew CR, Harvey SM, Warren JT.
Department of Psychological Sciences, Purdue University.
Reports an error in “Whose Intentions Predict? Power Over Condom Use Within Heterosexual Dyads” by Laura E. VanderDrift, Christopher R. Agnew, S. Marie Harvey and Jocelyn T. Warren (Health Psychology, Advanced Online Publication, Oct 1, 2012, np). Text was omitted from the author note. The text that should have been included is provided in the erratum. (The following abstract of the original article appeared in record 2012-26682-001.) According to major theories of behavioral prediction, the most proximal psychological predictor of an individual’s behavior is that individual’s intention. With respect to interdependent behaviors such as condom use, however, relationship dynamics influence individuals’ power to make decisions and to act.
Objective: The current study examines how relationship dynamics impact 3 condom use relevant outcomes: (a) the individual forming his or her own intention to use condoms, (b) the couple forming their joint intention to use condoms, and (c) actual condom use behavior.
Method: We conducted a 2-wave longitudinal study of young heterosexual adult couples at high risk for HIV infection involving the collection of both individual- and couple-derived data.
Results: Results demonstrate the importance of both person (e.g., biological sex and dispositional dominance) and relational (e.g., relational power and amount of interest in the relationship, operationalized as commitment and perceived alternatives to the relationship) factors in predicting condom use intentions and behavior. Individuals who are lower in dispositional dominance are likely to incorporate their partner’s intentions into their own individual intentions; the intentions of individuals who have less interest in the relationship are more highly predictive of the couple’s joint intention; and the intentions of men and individuals higher in relationship power are more likely to exert a direct influence on condom use.
Conclusions: These findings have implications for improving the health of high-risk individuals, including suggesting situations in which individuals are highly influenced by their partners’ intentions.
BMC Public Health. 2012 Nov 13;12(1):972. [Epub ahead of print]
Chi X, Yu L, Winter S.
Abstract/Link to free PDF: http://www.biomedcentral.com/1471-2458/12/972/abstract
BACKGROUND: In China, sexual health and behaviors of young people have become a growing public concern but few studies have been conducted to investigate the prevalence and psychosocial correlates of the phenomenon.
METHODS: A self-reported questionnaire survey on youth sexual behaviors was conducted among 1,500 university students in 2011 at Hefei, a middle-size city in eastern China. A total of 1,403 students (age = 20.30 +/- 1.27 years) completed the questionnaire with a high response rate of 93.5%.
RESULTS: Among the respondents, 12.6% (15.4% of male versus 8.6% of female) students reported having pre-marital heterosexual intercourse; 10.8% (10.5% of males versus 11.2% females) had oral sex; 2.7% (3.4% of males versus 1.7% females) reported same-sex activities; 46% (70.3% of males versus 10.8% of females) reported masturbation behaviors; 57.4% (86.2% of males versus 15.6% females) students viewed pornography. In terms of sexual communication about sexual knowledge acquisition, 13.7% (10.7% of males versus 18% of females) talked to their parents about sex; 7.1% (6.1% of males versus 8.4% of females) students reported having conversation with parents on contraception. About forcing sexual behavior, 2.7% (4% of males versus 0.9% of females) reported forcing their sexual partners to have sex, and 1.9% (2.4% of males versus 1.2% of females) reported being forced to have sex. Gender was found to be significant predictor of sexual behaviors in university students: males reported more sexual behaviors including sexual fantasy, heterosexual intercourse, masturbation, viewing pornography and talking about sex with friends. Several correlates of sexual behaviors were identified for students of different gender separately. For males, having romantic relationships, past sex education experiences, low educational aspirations, time spent on the Internet, and urban native settings were significantly associated with more sexual behaviors. For female students, having romantic relationships and urban native settings predicted sexual behaviors.
CONCLUSION: Sexual behavior among University students in China is not uncommon, although there are limited ways for students to acquire sex-related knowledge: male students showed significantly more sexual behaviors than female students. Having romantic relationships and more time spent online were important predictors of sexual behaviors among university students. To guide healthy sexual behaviors in young people, comprehensive sex education programs that provide necessary sexual health knowledge about safe sex should be developed and implemented in universities in China, particularly for students who have romantic relationships and those who spend long periods of time on the Internet.
Arch Sex Behav. 2012 Nov 14. [Epub ahead of print]
The Development of Conventional Sexual Partner Trajectories Among African American Male Adolescents.
Kogan SM, Yu T, Brody GH, Allen KA.
Department of Human Development and Family Science, University of Georgia, Athens, GA, firstname.lastname@example.org.
African American male youth disproportionately report involvement with multiple sexual partners, which increases their risk for sexually transmitted infections and initiation of unplanned pregnancies. Little is known about the developmental precursors of sexual partner trajectories among African American male youth. Moreover, few studies focus on the many African American youth who evince highly conventional sexual partner trajectories, i.e., youth who have only one partner or abstain from sexual activity across time. Using four waves of data from a longitudinal study, we hypothesized that an accumulation of social and economic disadvantages in early adolescence would negatively influence youths’ conventional sexual partner trajectories in late adolescence. We expected these disadvantages to affect youths’ receipt of protective family processes and their reports of a set of intrapersonal processes (self-regulation, hope, and low levels of anger) linked to generally conventional behavior. Hypotheses were tested with data from 315 African American male youth from 11 to 18.5 years of age and their primary caregivers. Our results supported the hypotheses. Socioeconomic disadvantages during preadolescence predicted less involvement in conventional sexual partner trajectories from ages 16 to 18.5 years. This association was mediated by protective family processes and a set of interrelated intrapersonal protective processes. Preventive interventions designed to promote protective parenting and intrapersonal processes can be expected to promote sexual behavior trajectories characterized by abstinence or relations with very few partners.
Int J STD AIDS. 2012 Nov;23(11):772-4.
Education provided to outgoing UK medical elective students regarding HIV risk and post exposure prophylaxis.
Stacey K, Sellers L, Barrett S.
College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham .
Previous studies suggested medical schools were failing to provide sufficient support for students undertaking electives in areas with high HIV prevalence and despite updated Department of Health (DoH) guidelines, not all were advising post exposure prophylaxis (PEP) starter packs where appropriate. This study assessed whether there has been improvement in risk reduction provided by home institutions. Questionnaires were emailed to all 29 UK medical schools offering an elective. A total of 26 medical schools responded. Only one failed to offer PEP starter packs or advice on where to obtain one. Support and advice provided by the other 25 varied considerably. HIV risk education and provision of PEP to elective students has improved. A discrepancy between advice given, supervision of projects and provision of PEP starter packs across UK medical schools remains. We reiterate recommendations put forward previously that there is a need for regularly updated national guidelines published by experts, issued to all medical schools.
Child Youth Serv Rev. 2012 Dec;34(12):2481-2486.
Individual and Social Network Sexual Behavior Norms of Homeless Youth at High Risk for HIV Infection.
Tyler KA, Melander LA.
University of Nebraska-Lincoln, Department of Sociology.
Although previous research shows that homeless youth engage in numerous risky sexual behaviors, little is known about whether or not specific rules govern this conduct within their social networks and how group norms influence subsequent sexual actions. The current study utilizes 19 in-depth interviews with homeless youth to investigate different elements of their sexual behavior. Findings reveal that their decision to have sex generally depends on chemistry and physical appearance whereas a potential partner’s risky sexual history and heavy substance use discourages youth from engaging in sex. Both males and females discuss condom usage as it relates to unknown sexual history, availability, pregnancy, and the prevention of sexually transmitted infections (STIs). Sixteen homeless youth indicate that they do not discuss safe sex practices with their partners or social network members.
Cult Health Sex. 2012 Nov 19. [Epub ahead of print]
Sexual abuse, social stigma and HIV vulnerability among young feminised men in Lahore and Karachi, Pakistan.
de Lind van Wijngaarden JW, Schunter BT, Iqbal Q.
Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne , Australia.
This study describes the experiences of 10 young feminised men in Pakistan. They face high levels of stigma, violence and sexual abuse. The average age of first sex was 11 years old and all reported having been been raped during childhood and early adolescence, often several times. While some mothers and siblings were quietly supportive, young feminised men often end up running away from home, finding support as a member of a hijra dera, a ‘pseudo-household’ led by an older feminised man or guru, in which they find employment as dancers or sex workers. After their entry into sex work there is little or no opportunity to use condoms. The hijra dera offer an important entry point for improved social support and sexual health programmes, including efforts to ensure young feminised men postpone their sexual debut and/or improve their sexual health, retain access to education, explore alternative forms of employment and improve access to health care.
J Am Coll Health. 2012 Dec;60(8):574-82.
Relative efficacy of a pregnancy, sexually transmitted infection, or human immunodeficiency virus prevention-focused intervention on changing sexual risk behavior among young adults.
Norton WE, Fisher JD, Amico KR, Dovidio JF, Johnson BT.
Department of Health Behavior , School of Public Health, University of Alabama at Birmingham , Birmingham , Alabama.
Objectives: Despite findings suggesting that young adults are more concerned about experiencing an unplanned pregnancy or contracting a sexually transmitted infection (STI) than becoming human immunodeficiency virus (HIV) infected, no empirical work has investigated whether the specific focus of an intervention may be more or less efficacious at changing sexual behavior.
Participants: Participants were 198 college students randomized to 1 of 4 conditions: pregnancy intervention, STI intervention, HIV intervention, or a control condition during 2008-2009.
Methods: The authors compared the efficacy of 3 theory-based, sexual risk-reduction interventions that were exactly the same except for an exclusive focus on preventing pregnancy, STI, or HIV. Condom use and risky sexual behavior were assessed at baseline and 4-week and 8-week follow-up.
Results: Participants exposed to the pregnancy or STI interventions reported greater condom use and less risky sexual behavior than those exposed to the HIV intervention.
Conclusions: The focus of sexual risk-reduction interventions may lead to differential behavior change among young adults.
J Law Med. 2012 Sep;20(1):93-123.
Criticisms of African trials fail to withstand scrutiny: male circumcision does prevent HIV infection.
Wamai RG, Morris BJ, Waskett JH, Green EC, Banerjee J, Bailey RC, Klausner JD, Sokal DC, Hankins CA.
Department of African-American Studies, Northeastern University, Boston, Massachusetts. email@example.com
A recent article in the JLM (Boyle GJ and Hill G, “Sub-Saharan African Randomised Clinical Trials into Male Circumcision and HIV Transmission: Methodological, Ethical and Legal Concerns” (2011) 19 JLM 316) criticises the large randomised controlled trials (RCTs) that scientists, clinicians and policy-makers worldwide have concluded provide compelling evidence in support of voluntary medical male circumcision (VMMC) as an effective HIV prevention strategy. The present article addresses the claims advanced by Boyle and Hill, demonstrating their reliance on outmoded evidence, outlier studies, and flawed statistical analyses. In the current authors’ view, their claims portray misunderstandings of the design, execution and interpretation of findings from RCTs in general and of the epidemiology of HIV transmission in sub-Saharan Africa in particular. At the same time they ignore systematic reviews and meta-analyses using all available data arising from good-quality research studies, including RCTs. Denial of the evidence supporting lack of male circumcision as a major determinant of HIV epidemic patterns in sub-Saharan Africa is unsubstantiated and risks undermining the evidence-based, large-scale roll-out of VMMC for HIV prevention currently underway. The present article highlights the quality, consistency and robustness of the scientific evidence that underpins the public health recommendations, guidance, and tools on VMMC. Millions of HIV infections will be averted in the coming decades as VMMC services scale-up to meet demand, providing direct benefits for heterosexual men and indirect benefits for their female partners.
Res Theory Nurs Pract. 2012;26(3):205-15.
Mahat G, Pradhan G.
College of Nursing, Rutgers, The State University of New Jersey, Newark, NJ. firstname.lastname@example.org
The purpose of this study was to explore HIV/AIDS knowledge and self-efficacy for limiting sexual risk behavior in Nepalese late adolescents attending college. A convenience sample of 229 baccalaureate college students completed three instruments: demographic, HIV/AIDS knowledge questions and the self-efficacy for limiting sexual risk behavior questions. The findings of this study showed that Nepalese youth had moderate HIV/AIDS knowledge and a moderate level of self-efficacy. However, they lacked knowledge in certain aspects of HIV transmission. HIV/AIDS knowledge was strongly correlated with self-efficacy for limiting sexual risk behavior. There was no statistical difference in HIV/AIDS knowledge and self-efficacy by gender. However, when each self-efficacy item was analyzed by gender, there were significant differences in a few items by gender. ANOVA analysis showed no significant differences on HIV/AIDS knowledge and self-efficacy by the level of education. The findings of this study indicate that there is a need for developing school-based and/or community-based programs that will increase HIV/AIDS awareness among youth and help them develop decision making and communication skills. It is also important to look at the school and college curricula and integrate more HIV/AIDS information in the curriculum.
HIV Testing, Diagnosis, Epidemological Issues (e.g. prevalence, incidence, mortality) Psych Testing, Attrition Article Summaries
PLoS One. 2012;7(11):e48077. Epub 2012 Nov 9.
Remis RS, Merid MF, Palmer RW, Whittingham E, King SM, Danson NS, Vernich L, Swantee C, Major C.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Free HTML/Link to free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0048077
In 1999, Ontario implemented a policy to offer HIV counseling and testing to all pregnant women and undertook measures to increase HIV testing. We evaluated the effectiveness of the new policy by examining HIV test uptake, the number of HIV-infected women identified and, in 2002, the HIV rate in women not tested during prenatal care. We analyzed test uptake among women receiving prenatal care from 1999 to 2010. We examined HIV test uptake and HIV rate by year, age and health region. In an anonymous, unlinked study, we determined the HIV rate in pregnant women not tested. Prenatal HIV test uptake in Ontario increased dramatically, from 33% in the first quarter of 1999 to 96% in 2010. Test uptake was highest in younger women but increased in all age groups. All health regions improved and experienced similar test uptake in recent years. The HIV rate among pregnant women tested in 2010 was 0.13/1,000; in Toronto, the rate was 0.28 per 1,000. In the 2002 unlinked study, the HIV rate was 0.62/1,000 among women not tested in pregnancy compared to 0.31/1,000 among tested women. HIV incidence among women who tested more than once was 0.05/1,000 person-years. In response to the new policy in Ontario, prenatal HIV testing uptake improved dramatically among women in all age groups and health regions. A reminder to physicians who had not ordered a prenatal HIV test appeared to be very effective. In 2002, the HIV rate in women who were not tested was twice that of tested women: though 77% of pregnant women had been tested, only 63% of HIV-infected women were tested. HIV testing uptake was estimated at 98% in 2010.
BMJ Open. 2012 Nov 14;2(6).
Assessment of simple risk markers for early mortality among HIV-infected patients in Guinea-Bissau: a cohort study.
Oliveira I, Andersen A, Furtado A, Medina C, da Silva D, da Silva ZJ, Aaby P, Laursen AL, Wejse C, Eugen-Olsen J; for the Bissau HIV cohort study group.
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
Free HTML/Link to free PDF: http://bmjopen.bmj.com/content/2/6/e001587.long
BACKGROUND: Decisions about when to start an antiretroviral therapy (ART) are normally based on CD4 cell counts and viral load (VL). However, these measurements require equipment beyond the capacity of most laboratories in low-income and middle-income settings. Thus, there is an urgent need to identify and test simple markers to guide the optimal time for starting and for monitoring the effect of ART in developing countries.
OBJECTIVES: (1) To evaluate anthropometric measurements and measurement of plasma-soluble form of the urokinase plasminogen activator receptor (suPAR) levels as potential risk factors for early mortality among HIV-infected patients; (2) to assess whether these markers could help identify patients to whom ART should be prioritised and (3) to determine if these markers may add information to CD4 cell count when VL is not available.
DESIGN: An observational study.
SETTING: The largest ART centre in Bissau, Guinea-Bissau.
PARTICIPANTS: 1083 ART-naïve HIV-infected patients.
OUTCOME MEASURES: Associations between baseline anthropometric measurements, CD4 cell counts, plasma suPAR levels and survival were examined using Cox proportional hazards models.
RESULTS: Low body mass index (BMI≤18.5 kg/m(2)), low mid-upper-arm-circumference (MUAC≤250 mm), low CD4 cell count (≤350 cells/μl) and high suPAR plasma levels (>5.3 ng/ml) were independent predictors of death. Furthermore, mortality among patients with low CD4 cell count, low MUAC or low BMI was concentrated in the highest suPAR quartile.
CONCLUSIONS: Irrespective of ART initiation and baseline CD4 count, MUAC and suPAR plasma levels were independent predictors of early mortality in this urban cohort. These markers could be useful in identifying patients at the highest risk of short-term mortality and may aid triage for ART when CD4 cell count is not available or when there is shortness of antiretroviral drugs.
Am J Med Sci. 2012 Nov 14. [Epub ahead of print]
Van Wagoner NJ, Morrow R, Lee J, Dixon P, Hook EW 3rd.
University of Alabama at Birmingham, Birmingham, Alabama; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington; University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Screening for subclinical herpes simplex virus type 2 (HSV-2) may be a useful adjunct in human immunodeficiency virus (HIV) care. However, HSV-2 serological tests have been suggested to perform less well in HIV-infected populations. In this study, HerpeSelect HSV-2 ELISA was compared with the Sure-Vue Rapid HSV-2 Test for HSV-2 screening of sera from 310 HIV-infected persons receiving care at an HIV-dedicated clinic in the Southeastern United States. In the study, assay agreement and whether the performance of both tests, rather than 1 test alone, would improve screening accuracy were determined. Overall percent test agreement was 96%. Negative percent agreement was best at a HerpeSelect index value <0.90 and positive percent agreement was best at a HerpeSelect index value ≥3.0 (97% and 100%, respectively). Using the manufacturer’s established cutoffs for a HerpeSelect positive test result versus negative test result, discordant results between assays occurred in 4% of the cases, and the majority of these cases occurred when the HerpeSelect index value was between 0.9 and 2.9. These data suggest a good correlation between the HerpeSelect and the Sure-Vue HSV-2 Rapid Test in a U.S. HIV-infected population and suggest that confirmatory testing may not help in HSV-2 diagnosis except in cases where HerpeSelect index values are between 0.9 and 3.0.
MEDICC Rev. 2012 Oct;14(4):26-31.
Audio Computer-Assisted Self Interview Compared to Traditional Interview in an HIV-Related Behavioral Survey in Vietnam.
Cu Le L, Vu LT.
Hanoi School of Public Health, Vietnam. email@example.com.
Free HTML/Link to free PDF: http://www.medicc.org/mediccreview/index.php?issue=22&id=275&a=vahtml
INTRODUCTION Globally, population surveys on HIV/AIDS and other sensitive topics have been using audio computer-assisted self interview for many years. This interview technique, however, is still new to Vietnam and little is known about its application and impact in general population surveys. One plausible hypothesis is that residents of Vietnam interviewed using this technique may provide a higher response rate and be more willing to reveal their true behaviors than if interviewed with traditional methods.
OBJECTIVE This study aims to compare audio computer-assisted self interview with traditional face-to-face personal interview and self-administered interview with regard to rates of refusal and affirmative responses to questions on sensitive topics related to HIV/AIDS. METHODS In June 2010, a randomized study was conducted in three cities (Ha Noi, Da Nan and Can Tho), using a sample of 4049 residents aged 15 to 49 years. Respondents were randomly assigned to one of three interviewing methods: audio computer-assisted self interview, personal face-to-face interview, and self-administered paper interview. Instead of providing answers directly to interviewer questions as with traditional methods, audio computer-assisted self-interview respondents read the questions displayed on a laptop screen, while listening to the questions through audio headphones, then entered responses using a laptop keyboard. A MySQL database was used for data management and SPSS statistical package version 18 used for data analysis with bivariate and multivariate statistical techniques. Rates of high risk behaviors and mean values of continuous variables were compared for the three data collection methods.
RESULTS Audio computer-assisted self interview showed advantages over comparison techniques, achieving lower refusal rates and reporting higher prevalence of some sensitive and risk behaviors (perhaps indication of more truthful answers). Premarital sex was reported by 20.4% in the audio computer-assisted self-interview survey group, versus 11.4% in the face-to-face group and 11.1% in the self-administered paper questionnaire group. The pattern was consistent for both male and female respondents and in both urban and rural settings. Men in the audio computer-assisted self-interview group also reported higher levels of high-risk sexual behavior-such as sex with sex workers and a higher average number of sexual partners-than did women in the same group. Importantly, item refusal rates on sensitive topics tended to be lower with audio computer-assisted self interview than with the other two methods.
CONCLUSIONS Combined with existing data from other countries and previous studies in Vietnam, these findings suggest that researchers should consider using audio computer-assisted self interview for future studies of sensitive and stigmatized topics, especially for men. KEYWORDS Behavioral research, community surveys, public health surveillance/methods, survey methods, effect modifier, epidemiologic biases, social desirability, HIV/AIDS, Vietnam.
MEDICC Rev. 2012 Oct;14(4):5-9.
Aragonés C, Campos JR, Pérez D, Martínez A, Pérez J.
Pedro Kourí Tropical Medicine Institute (IPK), Havana, Cuba. firstname.lastname@example.org.
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AIDS is a major cause of death in the Caribbean, a region with a high prevalence of HIV. However, prevalence in Cuba’s population aged 15 to 49 years, despite a slight increase in recent years, is considered extremely low (0.1%). At the close of 2010, 5692 Cuban patients were receiving antiretroviral therapy. SIDATRAT, an informatics system, was developed at the Pedro Kourí Tropical Medicine Institute in Havana to ensure proper monitoring and followup of drug administration. Functioning on a web platform utilizing an Apache server, PHP and MySQL, it records patients’ general information, CD4 counts, viral load and data from other laboratory tests, as well as endoscopic and imaging studies. It also compiles information on their AIDS classification, opportunistic infections, HIV subtype and resistance studies, followup consultations, drug regimen, adverse reactions to medications, changes in drug combinations, and survival; and tracks total number of individuals under treatment. SIDATRAT follows the client-server philosophy and enables access by authorized users throughout Cuba via the health informatics network. SIDATRAT has been found effective in supporting quality care for persons living with HIV/AIDS and universal access to antiretroviral therapy, compiling most of the information needed for decisionmaking on patient health and therapies. SIDATRAT has been offered to the UNDP office in Havana for sharing with other developing countries that may wish to adapt or implement it.
Nurs Res. 2012 Nov 10. [Epub ahead of print]
Norris AE, Hughes C, Hecht M, Peragallo N, Nickerson D.
College of Nursing, University of Central Florida, Orlando; Department of Electrical Engineering and Computer Science, University of Central Florida, Orlando. Pennsylvania State University, State College. University of Miami, Coral Gables, Florida. University of Central Florida, Orlando. Anne.Norris@ucf.edu.
BACKGROUND: Adolescents can use peer resistance skills to avoid being pressured into risky behavior, such as early sexual behavior. Avatar-based virtual reality technology offers a novel way to help build these skills.
OBJECTIVES: The aims of this study were to evaluate the feasibility of an avatar-based virtual reality peer resistance skill building game (DRAMA-RAMA), to explore the impact of game play on peer resistance self-efficacy, and to assess how positively the game was perceived.
METHODS: Forty-four low-income early adolescent Hispanic girls were assigned randomly to either the intervention (DRAMA-RAMA) or attention control game (Wii Dancing With the Stars) condition. All participants were offered a five-session curriculum that included peer resistance skill content before playing their respective game for 15 minutes, once a week, for 2 weeks. Participants completed electronic surveys at baseline, after game play, and at 2 months to assess demographics, peer resistance self-efficacy, and sexual behavior. They also completed a paper-pencil game experience questionnaire immediately after game play. Data were analyzed using descriptive statistics, t test, chi-square, and analyses of covariance.
RESULTS: Separate analyses of covariance showed a significant game effect at posttest for the peer resistance self-efficacy measure (F = 4.21, p < .05), but not at follow-up (F = 0.01, p = .92). DRAMA-RAMA was rated as positively as the Wii Dancing With the Stars (p > .26).
DISCUSSION: This randomized control trial provides preliminary support for the hypothesis that playing an avatar-based virtual reality technology game can strengthen peer resistance skills, and early adolescent Hispanic girls will have a positive response to this game.
Midwifery. 2012 Nov 10. [Epub ahead of print]
Kelly C, Alderdice F, Lohan M, Spence D.
South Eastern Health & Social Care Trust, Downe Hospital, Downpatrick, UK; School of Nursing & Midwifery, Queen’s University of Belfast, Medical Biology Centre, Belfast, UK. Electronic address: email@example.com.
OBJECTIVE: To explore HIV positive women’s experiences of pregnancy and maternity care, with a focus on their interactions with midwives.
DESIGN: A prospective qualitative study.
SETTING: Regional HIV unit in Northern Ireland.
PARTICIPANTS: 22 interviews were conducted with 10 women at different stages of their reproductive trajectories.
FINDINGS: The pervasive presence of HIV related stigma threatened the women’s experience of pregnancy and care. The key staff attributes that facilitated a positive experience were knowledge and experience, empathy and understanding of their unique needs and continuity of care.
KEY CONCLUSIONS: Pregnancy in the context of HIV, whilst offering a much needed sense of normality, also increases woman’s sense of anxiety and vulnerability and therefore the need for supportive interventions that affirm normality is intensified. A maternity team approach, with a focus on providing ‘balanced care’ could meet all of the woman and child’s medical needs, whilst also emphasising the normalcy of pregnancy.
J Sex Res. 2012 Nov 13. [Epub ahead of print]
A Multidimensional Framework for the Meanings of the Sexual Double Standard and its Application for the Sexual Health of Young Black Women in the U.S.
Fasula AM, Carry M, Miller KS.
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention.
There has been debate in the literature as to whether a sexual double standard (SDS) currently exists in the United States. Studies vary greatly in how the SDS is operationalized, making it difficult to interpret findings across studies and translate academic literature into applied fields such as public health. To advance academic and applied research, we propose a multidimensional framework for the SDS that can accommodate complex and nuanced meanings, is flexible enough to allow for the dynamic nature of social ideologies, and is grounded in an understanding of social systems of inequality. In this article, we describe three dimensions that define the broad elements of the SDS: (a) polarized (hetero)sexualities, (b) active male and passive female roles, and (c) the power struggle narrative. To illustrate the use of the framework, we contextualize each dimension in terms of the intersection of race and gender for young Black women in the United States. And finally, to apply the framework, we explore the effects the SDS can have on sexual health and suggest some directions for public health interventions. These analyses lay the groundwork for more complex and comprehensive investigations of the SDS and its effects on sexual health.
Int J Infect Dis. 2012 Nov 12. [Epub ahead of print]
Impact evaluation of a sexually transmitted disease preventive intervention among female sex workers in Hohhot, China.
Shi Y, Guo S, Bo F, Zhang X, Cao W, Wang P.
Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China.
OBJECTIVES: The aim of this study was to evaluate the impact of HIV and sexually transmitted disease (STD) prevention interventions among female sex workers (FSWs) in the city of Hohhot in northern China.
METHODS: Three serial cross-sectional surveys were conducted in 2006, 2007, and 2008 among FSWs. A questionnaire was administered to the FSWs, and HIV and syphilis tests were performed for all participants. Intervention activities including condom promotion and provision, increased condom availability and accessibility, and voluntary HIV counseling and testing (VCT) were carried out among FSWs.
RESULTS: There were 624 participants in the 2006 survey, 444 in the 2007 survey, and 451 in the 2008 survey. The United Nations General Assembly Special Session (UNGASS) indicators for FSWs increased from 13.9% in 2006 to 37.7% in 2008 (p<0.001). The average rate of consistent condom use with commercial clients in the month preceding the interview increased significantly from 39.8% in 2006 to 59.6% in 2008 (p<0.001). Not a single HIV-positive case was found among the FSWs over these 3 years, and the prevalence of syphilis decreased remarkably from 9.5% in 2006 to 1.3% in 2008. Logistic regression analysis showed that sauna or hair salon work venues, receiving services from intervention programs, and accepting HIV tests were factors associated with consistent condom use.
CONCLUSIONS: The findings suggest that consistent condom use and awareness of HIV/AIDS prevention-related knowledge among FSWs have been improved by the intervention. Further prioritized and combined prevention programs aimed at FSWs are needed in order to prevent the HIV/AIDS epidemic spreading in the general population in China.
Contraception. 2012 Nov 12. [Epub ahead of print]
Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia.
Khu NH, Vwalika B, Karita E, Kilembe W, Bayingana RA, Sitrin D, Roeber-Rice H, Learner E, Tichacek AC, Haddad LB, Wall KM, Chomba EN, Allen SA.
Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA. Electronic address: firstname.lastname@example.org.
BACKGROUND: HIV-discordant heterosexual couples are faced with the dual challenge of preventing sexual HIV transmission and unplanned pregnancies with the attendant risk of perinatal HIV transmission. Our aim was to examine uptake of two long-acting reversible contraceptive (LARC) methods – intrauterine devices (IUD) and hormonal implants – among HIV-discordant couples in Rwanda and Zambia.
STUDY DESIGN: Women were interviewed alone or with their partner during routine cohort study follow-up visits to ascertain fertility goals; those not pregnant, not infertile, not already using LARC, and wishing to limit or delay fertility for ≥3 years were counseled on LARC methods and offered an IUD or implant on-site.
RESULTS: Among 409 fertile HIV-discordant Rwandan women interviewed (126 alone, 283 with partners), 365 (89%) were counseled about LARC methods, and 130 (36%) adopted a method (100 implant, 30 IUD). Of 787 fertile Zambian women interviewed (457 alone, 330 with partners), 528 (67%) received LARC counseling, of whom 177 (34%) adopted a method (139 implant, 38 IUD). In both countries, a woman’s younger age was predictive of LARC uptake. LARC users reported fewer episodes of unprotected sex than couples using only condoms.
CONCLUSIONS: Integrated fertility goal-based family planning counseling and access to LARC methods with reinforcement of dual-method use prompted uptake of IUDs and implants and reduced unprotected sex among HIV-discordant couples in two African capital cities.
AIDS Behav. 2012 Nov 18. [Epub ahead of print]
HIV Knowledge and Sexual Risk Behavior Among Pregnant Couples in South Africa: The PartnerPlus Project.
Villar-Loubet OM, Cook R, Chakhtoura N, Peltzer K, Weiss SM, Shikwane ME, Jones DL.
Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, email@example.com.
In sub-Saharan Africa, 60 % of people living with HIV are women and most are of childbearing age. Alarmingly, seroconversion rates during pregnancy are high and increase as pregnancy progresses, highlighting the importance of increasing HIV-knowledge among pregnant women and their partners. This study compared sexual risk behavior, HIV knowledge and condom use pre- to post-partum among South African couples (n = 239 couples) randomly assigned to an intervention or an enhanced standard of care with the PMTCT protocol at rural community health antenatal clinics. Consistent condom use and HIV-related knowledge increased baseline to post-intervention and was maintained at long term follow up post-partum among participants in the intervention condition. HIV knowledge mediated the relationship between the intervention and consistent condom use. Results from this pilot study provide support for the integration of HIV risk reduction interventions for both women and men into existing PMTCT services during and following pregnancy.
Curr HIV/AIDS Rep. 2012 Nov 17. [Epub ahead of print]
HIV/STI Risk Among Venue-Based Female Sex Workers Across the Globe: A Look Back and the Way Forward.
Pitpitan EV, Kalichman SC, Eaton LA, Strathdee SA, Patterson TL.
Division of Global Public Health, Department of Medicine, University of California San Diego, School of Medicine, La Jolla, CA, firstname.lastname@example.org.
Female sex workers (FSWs) continue to represent a high-risk population in need of targeted HIV prevention interventions. Targeting environmental risk factors should result in more sustainable behavior change than individual-level interventions alone. There are many types of FSWs who operate in and through a variety of micro- (eg, brothels) and macro-level (eg, being sex-trafficked) contexts. Efforts to characterize FSWs and inform HIV prevention programs have often relied on sex work typologies or categorizations of FSWs by venue or type. We conducted a systematic search and qualitatively reviewed 37 published studies on venue-based FSWs to examine the appropriateness of sex work typologies, and the extent to which this research has systematically examined characteristics of different risk environments. We extracted information on study characteristics like venue comparisons, HIV/STI prevalence, and sampling strategies. We found mixed results with regards to the reliability of typologies in predicting HIV/STI infection; relying solely on categorization of FSWs by venue or type did not predict seroprevalence in a consistent manner. Only 65 % of the studies that allowed for venue comparisons on HIV/STI prevalence provided data on venue characteristics. The factors that were assessed were largely individual-level FSW factors (eg, demographics, number of clients per day), rather than social and structural characteristics of the risk environment. We outline a strategy for future research on venue-based FSWs that ultimately aims to inform structural-level HIV interventions for FSWs.
Curr Opin Obstet Gynecol. 2012 Dec;24(6):395-401.
Senise J, Bonafé S, Castelo A.
Division of Infectious Diseases, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
PURPOSE OF REVIEW: The purpose of this article is to update the current practice in the management of HIV-infected pregnant women and present evidence-based recommendations for the reduction of mother-to-child transmission.
RECENT FINDINGS: Early and sustained control of HIV viral replication is associated with decreasing residual risk of transmission and favors initiating antiretroviral drugs sufficiently early in naive women to suppress viral replication by the third trimester; however, this potential benefit must be balanced against the unknown long-term outcome of first-trimester drug exposure. Efavirenz should whenever possible be avoided in the first trimester of gestation, but its use seems well tolerated for 39 days after last menstrual period when the neural tube closes. Raltegravir may be considered in special circumstances in pregnancy.
SUMMARY: The HIV viral load and the risk factors for prematurity must be considered when deciding when to start antiretroviral treatment in each individual pregnant woman. A ritonavir-boosted protease inhibitor combined with two nucleoside reverse transcriptase inhibitors is currently the most widely used regimen. Among protease inhibitors, lopinavir combined with ritonavir is the most frequently used; however, atazanavir combined with ritonavir is a good alternative. Elective cesarean section is the best delivery mode for pregnant women with viral loads more than 50 copies/ml.
Span J Psychol. 2012 Nov;15(3):1303-14.
Pereira M, Canavarro MC.
Instituto de Psicologia Cognitiva, Desenvolvimento Vocacional e Social, Faculdade de Psicologia e Ciências da Educação da Universidade de Coimbra, Apartado, Coimbra, Portugal. email@example.com
The purpose of this preliminary study was to describe the quality of life (QOL) and emotional distress during pregnancy and early postpartum, and to examine the ability of psychopathological symptoms to predict QOL at early postpartum. A sample of 75 pregnant women (31 HIV-positive and 44 HIV-negative) was assessed during the second trimester of pregnancy and two to four days postpartum. QOL was assessed with the WHOQOL-Bref. The emotional distress was assessed with the Brief Symptom Inventory, and with the Emotional Assessment Scale. Seropositive women reported increased negative emotional reactivity and lower scores in social relationships and overall QOL during pregnancy than HIV-negative women. Both HIV-positive and HIV-negative women reported better QOL after the birth of their child, when compared with the pregnancy period. Among HIV-positive women, lower anxiety and depressive symptoms during pregnancy were, respectively, significant predictors of better psychological QOL and overall QOL at early postpartum. Less intense somatic symptoms predicted better physical QOL. Longitudinal assessment of QOL and emotional status may provide potentially useful information for tailoring psychological interventions in the maternity care of HIV-infected women, during their transition to motherhood.
Res Theory Nurs Pract. 2012;26(3):182-204.
Do social support, stigma, and social problem-solving skills predict depressive symptoms in people living with HIV? A mediation analysis.
White W, Grant JS, Pryor ER, Keltner NL, Vance DE, Raper JL.
Pensacola State College.
Social support, stigma, and social problem solving may be mediators of the relationship between sign and symptom severity and depressive symptoms in people living with HIV (PLWH). However, no published studies have examined these individual variables as mediators in PLWH. This cross-sectional, correlational study of 150 PLWH examined whether social support, stigma, and social problem solving were mediators of the relationship between HIV-related sign and symptom severity and depressive symptoms. Participants completed self-report questionnaires during their visits at two HIV outpatient clinics in the Southeastern United States. Using multiple regression analyses as a part of mediation testing, social support, stigma, and social problem solving were found to be partial mediators of the relationship between sign and symptom severity and depressive symptoms, considered individually and as a set.
Res Theory Nurs Pract. 2012;26(3):167-81.
Faculty of Health Science, School of Nursing, University of Ottawa, Ontario, Canada. firstname.lastname@example.org
Although communicable disease public health practice has traditionally been based on numbers (e.g., incidence, prevalence), in the domain of HIV prevention and control qualitative research has recently become a more commonly employed data collection strategy. Of particular benefit, this approach can supplement the numbers which typically underpin public health strategies by generating in-depth understandings about how specific populations define, describe, and perceive their health and the factors that affect it. However, the use of qualitative research in public health must be explored; it cannot simply be accepted without reflection or analysis. To guide such an investigation, the work of Michel Foucault and Michael Hardt and Antonio Negri is used to examine two previous research projects that were undertaken by the author. The outcome of this analysis is the somewhat paradoxical conclusion that although qualitative research can enhance public health work, it may also be a strategy that generates the information that can be used for capturing and normalizing marginalized populations. Qualitative research, in other words, may be a technique that can be used to achieve biopolitical goals.
Afr J Psychiatry (Johannesbg). 2012 Nov;15(6):424-3426.
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
The large number of persons living with HIV in Southern Africa has implications for mental health services for this population. Data have emerged in recent years showing that a substantial number of persons living with HIV also have mental health problems. Yet, the practice of routine screening for psychiatric disorders in the context of HIV care is controversial. Moreover, common mental health problems, if left undetected and untreated, may have severe consequences for adherence to antiretroviral therapy (ART), which in turn will likely lead to severe health consequences for patients. There are high costs associated with employing professional psychologists, counsellors, and social workers to provide psychosocial support to ART users. As a result, in many contexts lay counsellors and patient advocates have been employed as a less costly alternative. High standards of training of lay counsellors, as well as on-going supervision and support to patient advocates is necessary to ensure optimal outcomes/results.
Afr J Psychiatry (Johannesbg). 2012 Nov;15(6):420-3.
Joska JA, Sorsdahl KR.
Department of Psychiatry and Mental Health, Division of Neuropsychiatry, University of Cape Town, Cape Town, South Africa.
Mental disorders are highly prevalent across all health settings. Where they are co-morbid with other chronic physical disorders, a complex bidirectional relationship exists between them. While mental disorders may result in an increase in adverse healthrelated outcomes, they are amenable to cost-effective treatments. In resource-limited settings, many barriers to the detection and treatment of mental disorders exist. One approach to the effective targeting of the available resources is to utilize a “risk-flag” approach, wherein individuals at-risk of treatment failure are identified and routed into more intensive mental health screening and intervention. This paper discusses how lessons from HIV services may inform how to improve mental health care and integration in HIV settings, as well as in other chronic diseases.
Indian J Pediatr. 2012 Nov 13. [Epub ahead of print]
Mothi SN, Swamy VH, Lala MM, Karpagam S, Gangakhedkar RR.
Department of Pediatrics, Asha Kirana Charitable Trust, Mysore, Karnataka, India, email@example.com.
The term “Adolescence” literally means “to emerge” or “to attain identity” and is essentially the period of rapid physical and psychological development starting from the onset of puberty to complete growth. All adolescents go through a myriad of physical, psychological, neurobehavioural, hormonal and social developmental changes. Given the social taboos often surrounding puberty, the lives of millions of adolescents worldwide are at risk because they do not have the information, skills, health services and support they need to go through the enormous, rapid changes that adolescence brings. A HIV infected adolescent particularly presents enormous challenges in the current cultural and social context of India. The distinct groups of adolescents in the context of HIV are those who were infected at birth and survived and those who became infected during adolescence. Risk factors and situations for adolescents contracting HIV infection are life on streets, lack of adult love/care and support, extreme poverty, child trafficking, migrant population, exploitation in terms of sex and labor. HIV-infected adolescents with long standing HIV infection often face considerable physical challenges – delayed growth and development, late puberty, stunting/wasting, malnutrition, etc. Added to this are many other challenges related mainly to disclosure of HIV status, developmental delay, and transition from pediatric to adult care, including the choice of appropriate treatment regimens and adherence. Psychological and social factors deeply impact the ability to deal with the illness and must be addressed at all levels to encourage and support this vulnerable group.
Top Antivir Med. 2012 Oct;20(4):134-8.
Syphilis negatively influences the response to hepatitis C virus treatment in an HIV-infected patient.
Nagami EH, Kim AY, Baden RP, McGovern BH.
Harvard University Center for AIDS Research, Boston, MA.
Syphilis is a chronic inflammatory disease caused by the sexually transmitted pathogen, Treponema pallidum. Concomitant HIV and syphilis infections are prevalent among men who have sex with men (MSM). Syphilis negatively impacts disease management in the HIV-infected host by causing substantial immune activation, as evidenced by precipitous declines of CD4+ cells and by increased levels of HIV RNA. Syphilis has also been reported as a risk factor for hepatitis C virus (HCV) acquisition among MSM. Whether intercurrent syphilis has any negative impact on HCV treatment response is unknown. This case report proposes that active symphilis infection may have been a key contributor to the patient’s slow virologic response to his initial course of HCV treatment.
AIDS Behav. 2012 Nov 18. [Epub ahead of print]
Althoff AL, Zelenev A, Meyer JP, Fu J, Brown SE, Vagenas P, Avery AK, Cruzado-Quiñones J, Spaulding AC, Altice FL.
AIDS Program, Yale University School of Medicine, New Haven, CT, firstname.lastname@example.org.
Retention in care is key to effective HIV treatment, but half of PLWHA in the US are continuously engaged in care. Incarcerated individuals are an especially challenging population to retain, and empiric data specific to jail detainees is lacking. We prospectively evaluated correlates of retention in care for 867 HIV-infected jail detainees enrolled in a 10-site demonstration project. Sustained retention in care was defined as having a clinic visit during each quarter in the 6 month post-release period. The following were independently associated with retention: being male (AOR = 2.10, p ≤ 0.01), heroin use (AOR 1.49, p = 0.04), having an HIV provider (AOR 1.67, p = 0.02), and receipt of services: discharge planning (AOR 1.50, p = 0.02) and disease management session (AOR 2.25, p ≤ 0.01) during incarceration; needs assessment (AOR 1.59, p = 0.02), HIV education (AOR 2.03, p ≤ 0.01), and transportation assistance (AOR 1.54, p = 0.02) after release. Provision of education and case management services improve retention in HIV care after release from jail.
AIDS Behav. 2012 Nov 16. [Epub ahead of print]
Rapp RC, Ciomcia R, Zaller N, Draine J, Ferguson A, Cagey R.
Boonshoft School of Medicine, Wright State University, Clayton, OH, email@example.com.
HIV testing in jails has provided public health officials with the opportunity to not only identify new cases of HIV but to also reestablish contact with previously diagnosed individuals, many of whom never entered care following diagnosis or entered care but then dropped out. The presence of inmates throughout the HIV/AIDS continuum of care suggests that jails can play a strategic role in engaging persons living with HIV and AIDS in care. In order to be successful in structuring HIV/AIDS programs in jails, health care and correctional officials will be well-served to: (1) understand the HIV/AIDS continuum of care from the standpoint of engagement interventions that promote participation; (2) be aware of jail, community, and prison interventions that promote engagement in care; (3) anticipate and plan for the unique barriers jails provide in implementing engagement interventions; and, (4) be creative in designing engagement interventions suitable for both newly and previously diagnosed individuals.
J Neurosci. 2012 Nov 14;32(46):16306-13.
Human Immunodeficiency Virus Type 1 (HIV-1) Transactivator of Transcription through Its Intact Core and Cysteine-Rich Domains Inhibits Wnt/β-Catenin Signaling in Astrocytes: Relevance to HIV Neuropathogenesis.
Henderson LJ, Sharma A, Monaco MC, Major EO, Al-Harthi L.
Department of Immunology/Microbiology, Rush University Medical Center, Chicago, Illinois; National Institute of Neurological Disease and Stroke, National Institutes of Health, Bethesda, Maryland.
Wnt/β-catenin is a neuroprotective pathway regulating cell fate commitment in the CNS and many vital functions of neurons and glia. Its dysregulation is linked to a number of neurodegenerative diseases. Wnt/β-catenin is also a repressor of HIV transcription in multiple cell types, including astrocytes, which are dysregulated in HIV-associated neurocognitive disorder. Given that HIV proteins can overcome host restriction factors and that perturbations of Wnt/β-catenin signaling can compromise astrocyte function, we evaluated the impact of HIV transactivator of transcription (Tat) on Wnt/β-catenin signaling in astrocytes. HIV clade B Tat, in primary progenitor-derived astrocytes and U87MG cells, inhibited Wnt/β-catenin signaling as demonstrated by its inhibition of active β-catenin, TOPflash reporter activity, and Axin-2 (a downstream target of Wnt/β-catenin signaling). Point mutations in either the core region (K41A) or the cysteine-rich region (C30G) of Tat abrogated its ability to inhibit β-catenin signaling. Clade C Tat, which lacks the dicysteine motif, did not alter β-catenin signaling, confirming that the dicysteine motif is critical for Tat inhibition of β-catenin signaling. Tat coprecipitated with TCF-4 (a transcription factor that partners with β-catenin), suggesting a physical interaction between these two proteins. Furthermore, knockdown of β-catenin or TCF-4 enhanced docking of Tat at the TAR region of the HIV long terminal repeat. These findings highlight a bidirectional interference between Tat and Wnt/β-catenin that negatively impacts their cognate target genes. The consequences of this interaction include alleviation of Wnt/β-catenin-mediated suppression of HIV and possible astrocyte dysregulation contributing to HIV neuropathogenesis.
Top Antivir Med. 2012 Oct;20(4):129-33.
University of Wisconsin School of Medicine and Public Health, Madison, WI.
HIV infection and antiretroviral therapy each appear to increase cardiovascular disease risk. Increased risk may be attributable to the inflammatory effects of HIV infection and dyslipidemia associated with some antiretroviral agents. The prevalence of cardiovascular disease is increasing as patients live longer, age, and acquire traditional coronary heart disease (CHD) risk factors. In general, any additional cardiovascular risk posed by HIV infection or antiretroviral therapy is of potential concern for patients who are already at moderate or high risk for CHD. Long-term and well-designed studies are needed to more accurately ascertain to what degree HIV infection and antiretroviral therapy affect long-term cardiovascular disease risk. Management of dyslipidemia to reduce CHD risk in HIV-infected patients is much the same as in the general population, with the cornerstone consisting of statin therapy and lifestyle interventions. Smoking cessation is a major step in reducing CHD risk in those who smoke. This article summarizes a presentation by James H. Stein, MD, at the IAS-USA live continuing medical education activity held in New York City in March 2012.
Rev Inst Med Trop Sao Paulo. 2012 Dec;54(6):345-8.
Corti M, Villafañe MF, Marona E, Lewi D.
Division of HIV/AIDS, Infectious Diseases F. J. Muñiz Hospital, Buenos Aires, Argentina.
Free HTML/Link to free PDF: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652012000600010&lng=en&nrm=iso&tlng=en
Squamous anal cell carcinoma is a rare malignancy that represents the 1.5% to 2% of all the lower digestive tract cancers. However, an increased incidence of invasive anal carcinoma is observed in HIV-seropositive population since the widespread of highly active antiretroviral therapy. Human papillomavirus is strongly associated with the pathogenesis of anal cancer. Anal intercourse and a high number of sexual partners appear to be risk factors to develop anal cancer in both sexes. Anal pain, bleeding and a palpable lesion in the anal canal are the most common clinical features. Endo-anal ultrasound is the best diagnosis method to evaluate the tumor size, the tumor extension and the infiltration of the sphincter muscle complex. Chemoradiotherapy plus antiretroviral therapy are the recommended treatments for all stages of localized squamous cell carcinoma of the anal canal in HIV-seropositive patients because of its high rate of cure. Here we present an HIV patient who developed a carcinoma of the anal canal after a long time of HIV infection under highly active antiretroviral therapy with a good virological and immunological response.
PLoS One. 2012;7(11):e49289. Epub 2012 Nov 9.
Pharmacologic Boosting of Atazanavir in Maintenance HIV-1 Therapy: The COREYA Propensity-Score Adjusted Study.
Hocqueloux L, Choisy P, Le Moal G, Borsa-Lebas F, Plainchamp D, Legac E, Prazuck T, de la Tribonnière X, Yazdanpanah Y, Parienti JJ.
Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional, Orléans, France.
Free HTML/Link to free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0049289
BACKGROUND: Among HIV-1 infected patients who achieved virologic suppression, the use of atazanavir without pharmacologic boosting is debated. We evaluated the efficacy and tolerance of maintenance therapy with unboosted atazanavir in clinical practice.
METHODS AND RESULTS: This multicenter retrospective cohort study evaluated the efficacy of switching HIV-1-infected patients controlled on triple therapy to unboosted (ATV(0), n = 98) versus ritonavir-boosted atazanavir (ATV/r, n = 254) +2 nucleos(t)ide reverse transcriptase inhibitors. The primary endpoint was time to virologic failure (VF, >200 copies/mL). ATV groups were compared controlling for potential confounding bias by inverse probability weighted Cox analysis and propensity-score matching. Overall and adjusted VF rates were similar for both strategies. Both strategies improved dyslipidemia and creatininemia, with less jaundice in the ATV(0) group.
CONCLUSION: In previously well-suppressed patients, within an observational cohort setting, ATV(0)-based triple-therapy appeared as effective as ATV/r- based triple-therapy to maintain virologic suppression, even if co-administered with TDF, but was better tolerated.
PLoS One. 2012;7(11):e40623. Epub 2012 Nov 12.
Incidence, Clinical Spectrum, Risk Factors and Impact of HIV-Associated Immune Reconstitution Inflammatory Syndrome in South Africa.
Haddow LJ, Moosa MY, Mosam A, Moodley P, Parboosing R, Easterbrook PJ.
University College London, London, United Kingdom ; University of KwaZulu-Natal, Durban, South Africa.
Free HTML/Link to free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0040623
BACKGROUND: Immune reconstitution inflammatory syndrome (IRIS) is a widely recognised complication of antiretroviral therapy (ART), but there are still limited data from resource-limited settings. Our objective was to characterize the incidence, clinical spectrum, risk factors and contribution to mortality of IRIS in two urban ART clinics in South Africa.
METHODS AND FINDINGS: 498 adults initiating ART in Durban, South Africa were followed prospectively for 24 weeks. IRIS diagnosis was based on consensus expert opinion, and classified by mode of presentation (paradoxical worsening of known opportunistic infection [OI] or unmasking of subclinical disease). 114 patients (22.9%) developed IRIS (36% paradoxical, 64% unmasking). Mucocutaneous conditions accounted for 68% of IRIS events, mainly folliculitis, warts, genital ulcers and herpes zoster. Tuberculosis (TB) accounted for 25% of IRIS events. 18/135 (13.3%) patients with major pre-ART OIs (e.g. TB, cryptococcosis) developed paradoxical IRIS related to the same OI. Risk factors for this type of IRIS were baseline viral load >5.5 vs. <4.5 log(10) (adjusted hazard ratio 7.23; 95% confidence interval 1.35-38.76) and ≤30 vs. >30 days of OI treatment prior to ART (2.66; 1.16-6.09). Unmasking IRIS related to major OIs occurred in 25/498 patients (5.0%), and risk factors for this type of IRIS were baseline C-reactive protein ≥25 vs. <25 mg/L (2.77; 1.31-5.85), haemoglobin <10 vs. >12 g/dL (3.36; 1.32-8.52), ≥10% vs. <10% weight loss prior to ART (2.31; 1.05-5.11) and mediastinal lymphadenopathy on pre-ART chest x-ray (9.15; 4.10-20.42). IRIS accounted for 6/25 (24%) deaths, 13/65 (20%) hospitalizations and 10/35 (29%) ART interruptions or discontinuations.
CONCLUSION: IRIS occurred in almost one quarter of patients initiating ART, and accounted for one quarter of deaths in the first 6 months. Priority strategies to reduce IRIS-associated morbidity and mortality in ART programmes include earlier ART initiation before onset of advanced immunodeficiency, improved pre-ART screening for TB and cryptococcal infection, optimization of OI therapy prior to ART initiation, more intensive clinical monitoring in initial weeks of ART, and education of health care workers and patients about IRIS.
FASEB J. 2012 Nov 12. [Epub ahead of print]
Neurosteroid-mediated regulation of brain innate immunity in HIV/AIDS: DHEA-S suppresses neurovirulence.
Maingat FG, Polyak MJ, Paul AM, Vivithanaporn P, Noorbakhsh F, Ahboucha S, Baker GB, Pearson K, Power C.
University of Alberta, Edmonton, AB, Canada
Neurosteroids are cholesterol-derived molecules synthesized within the brain, which exert trophic and protective actions. Infection by human and feline immunodeficiency viruses (HIV and FIV, respectively) causes neuroinflammation and neurodegeneration, leading to neurological deficits. Secretion of neuroinflammatory host and viral factors by glia and infiltrating leukocytes mediates the principal neuropathogenic mechanisms during lentivirus infections, although the effect of neurosteroids on these processes is unknown. We investigated the interactions between neurosteroid-mediated effects and lentivirus infection outcomes. Analyses of HIV-infected (HIV(+)) and uninfected human brains disclosed a reduction in neurosteroid synthesis enzyme expression. Human neurons exposed to supernatants from HIV(+) macrophages exhibited suppressed enzyme expression without reduced cellular viability. HIV(+) human macrophages treated with sulfated dehydroepiandrosterone (DHEA-S) showed suppression of inflammatory gene (IL-1β, IL-6, TNF-α) expression. FIV-infected (FIV(+)) animals treated daily with 15 mg/kg body weight. DHEA-S treatment reduced inflammatory gene transcripts (IL-1β, TNF-α, CD3ε, GFAP) in brain compared to vehicle-(β-cyclodextrin)-treated FIV(+) animals similar to levels found in vehicle-treated FIV(-) animals. DHEA-S treatment also increased CD4(+) T-cell levels and prevented neurobehavioral deficits and neuronal loss among FIV(+) animals, compared to vehicle-treated FIV(+) animals. Reduced neuronal neurosteroid synthesis was evident in lentivirus infections, but treatment with DHEA-S limited neuroinflammation and prevented neurobehavioral deficits. Neurosteroid-derived therapies could be effective in the treatment of virus- or inflammation-mediated neurodegeneration.-Maingat, F. G., Polyak, M. J., Paul, A. M., Vivithanaporn, P., Noorbakhsh, F., Ahboucha S., Baker, G. B., Pearson, K., Power, C. Neurosteroid-mediated regulation of brain innate immunity in HIV/AIDS: DHEA-S suppresses neurovirulence.
Subcell Biochem. 2013;61:479-505.
Dhamija N, Rawat P, Mitra D.
National Centre for Cell Science, NCCS Complex, Pune University Campus, Ganeshkhind, Pune, India.
Despite the intense effort put by researchers globally to understand Human Immunodeficiency Virus (HIV-1) pathogenesis since its discovery 30 years ago, the acquired knowledge till date is not good enough to eradicate HIV-1 from an infected individual. HIV-1 infects cells of the human immune system and integrates into the host cell genome thereby leading to persistent infection in these cells. Based on the activation status of the cells, the infection could be productive or result in latent infection. The current regimen used to treat HIV-1 infection in an AIDS patient includes combination of antiretroviral drugs called Highly Active Anti-Retroviral Therapy (HAART). A major challenge for the success of HAART has been these latent reservoirs of HIV which remain hidden and pose major hurdle for the eradication of virus. Combination of HAART therapy with simultaneous activation of latent reservoirs of HIV-1 seems to be the future of anti-retroviral therapy; however, this will require a much better understanding of the mechanisms and regulation of HIV-1 latency. In this chapter, we have tried to elaborate on HIV-1 latency, highlighting the strategies employed by the virus to ensure persistence in the host with specific focus on epigenetic regulation of latency. A complete understanding of HIV-1 latency will be extremely essential for ultimate eradication of HIV-1 from the human host.
Neurobiol Aging. 2012 Nov 15. [Epub ahead of print]
Chang L, Holt JL, Yakupov R, Jiang CS, Ernst T.
Department of Medicine, Division of Neurology, John A. Burns School of Medicine, University of Hawai’i at Manoa, and the Queen’s Medical Center, Honolulu, HI. Electronic address: firstname.lastname@example.org.
More HIV-infected individuals are living longer; however, how their brain function is affected by aging is not well understood. One hundred twenty-two men (56 seronegative control [SN] subjects, 37 HIV subjects with normal cognition [HIV+NC], 29 with HIV-associated neurocognitive disorder [HAND]) performed neuropsychological tests and had acceptable functional magnetic resonance imaging scans at 3 Tesla during tasks with increasing attentional load. With older age, SN and HIV+NC subjects showed increased activation in the left posterior (reserve, “bottom-up”) attention network for low attentional-load tasks, and further increased activation in the left posterior and anterior (“top-down”) attention network on intermediate (HIV+NC only) and high attentional-load tasks. HAND subjects had only age-dependent decreases in activation. Age-dependent changes in brain activation differed between the 3 groups, primarily in the left frontal regions (despite similar brain atrophy). HIV and aging act synergistically or interactively to exacerbate brain activation abnormalities in different brain regions, suggestive of a neuroadaptive mechanism in the attention network to compensate for declined neural efficiency. While the SN and HIV+NC subjects compensated for their declining attention with age by using reserve and “top-down” attentional networks, older HAND subjects were unable to compensate which resulted in cognitive decline.
AIDS Res Hum Retroviruses. 2012 Nov 13. [Epub ahead of print]
Effect of Efavirenz, Nevirapine, Etravirine, Raltegravir Administration on the Pharmacokinetics of Ritonavir-Boosted Darunavir in a Population of HIV-infected Patients.
Dailly E, Allavena C, Bouquié R, Deslandes G, Raffi F, Jolliet P.
University Hospital of Nantes, Clinical pharmacology, Nantes, France; email@example.com.
The influence of efavirenz, etravirine, raltegravir, nevirapine administration on the pharmacokinetics of ritonavir-boosted darunavir was investigated using population pharmacokinetics analysis. The population was composed of 142 patients infected with HIV: darunavir plus nucleoside/nucleotide reverse transcriptase inhibitors (NRTI), 54 patients (group A); darunavir plus efavirenz ± NRTI, 4 patients (group B); darunavir plus etravirine ± NRTI, 5 patients (group C); darunavir plus nevirapine ± NRTI, 21 patients (group D); darunavir plus raltegravir ± NRTI, 38 patients (group E); and darunavir plus raltegravir and etravirine ± NRTI, 20 patients (group F). A significant increase in darunavir clearance in combination with nevirapine (+66%) and efavirenz (+235%) was observed. A significant decrease (p<0.05) in trough plasma concentration was observed in groups B and D compared with the other groups. Our study indicates that the combination of ritonavir-boosted darunavir and etravirine or raltegravir has no significant influence on the pharmacokinetics of darunavir in contrast to the combination of ritonavir-boosted darunavir and nevirapine or efavirenz, which involves an increase in darunavir clearance and a decrease in the plasma concentration of darunavir.
Ann Med. 2012 Nov 17. [Epub ahead of print]
Update on rilpivirine: A new potent non-nucleoside reverse transcriptase inhibitor (NNRTI) of HIV replication.
Zaharatos GJ, Wainberg MA.
Division of Infectious Diseases, Jewish General Hospital, Montreal, Canada.
Introduction. A combination of antiretroviral drugs (ARVs) is necessary to achieve sustained virologic suppression of HIV viral load (< 50 copies/mL). Rilpivirine (RPV) is a potent new non-nucleoside reverse transcriptase inhibitor (NNRTI) that has the potential to be part of effective ARV combinations. Here, we review currently available data on RPV from the standpoint of virologic suppression and efficacy, drug-drug interactions safety, and resistance.
Areas covered. This review presents data on the results of clinical trials involving RPV. The topics considered include antiviral potency, dosing, clinical utility, drug resistance, toxicity profile, and pharmacokinetics.
Expert opinion. RPV is a potent new addition to the antiretroviral family of drugs for use in combination therapy in previously untreated HIV-infected patients. However, caution needs to be exercised in administration of RPV to patients who initiated therapy with viral loads > 100,000 viral RNA copies/mL.
DATE: 6 November 2012
Researchers have discovered a more effective solution to teaching sex education. A team of researchers from the University of Ottawa, the University of Toronto, and Yale University, using researchers in South America, studied the behavior and attitudes of Colombian ninth graders who took a sex education course.
Profamilia, an arm of Planned Parenthood International, provided the course at a cost of $14 per student. The study tracked 138 ninth graders from 69 public schools in 21 Colombian cities who took a semester-long course. Each day, the students spent 90 minutes in class on the computer, working through interactive modules and quizzes on topics such as pregnancy, sexual rights, contraceptives, and infections. Students could ask questions and get feedback by private communication with a remote Profamilia tutor. University of Toronto Assistant Professor, Marco Gonzalez-Navarro, explained that it can be awkward for teenagers to discuss sexual activity, so the students had an advantage in working online for this course and having access to the remote tutor. Researchers carried out a survey of baseline attitudes before the course began, one week after the course had been completed, and six months later. Students were also given vouchers for condoms six months after the course.
The results of the study showed a reduction in self-reported infections for those students who were sexually active when the course started and a 10 percent increase in condom use among students who had taken the course. The sexually active teens increased their condom use, had fewer sexually transmitted infections (STIs), and showed a greater awareness of sexually abusive situations. Gonzalez-Navarro noted that there was a significant, positive impact on sexual behavior among friend groups who had taken the course. The researchers published the study as a working paper.
DATE: 3 November 2012
Condoms have a 15 percent failure rate. Also, they do not completely protect against sexually transmitted diseases (STDs). However, when researchers at the University of Manitoba soaked condoms in a solution of microscopic silver nanoparticles, the condoms seemed to kill all HIV and herpes viruses in lab experiments.
Silver has been known to have disinfectant powers, but its effectiveness was not reliable. According to Dr. Xiaojian Yao, lead author of the study, when silver was used in a nanoparticle form, it seemed to become more effective at fighting off bacteria and viruses. The small size of the nanoparticles also enabled the researchers to place them on a polyurethane condom without changing its size or shape. The researchers do not know exactly how the silver nanoparticles neutralize HIV and other viruses.
Dr. Yao added that the silver nanoparticles do not cause inflammation. Currently, there are condoms treated with the antimicrobial called Nonoxynol-9, but these can cause inflammation and genital ulcers, which may make infection more likely. Also Dr. Yao noted that the treated condoms are quickly discarded, so that the potentially toxic metal does not remain in users’ bodies. Another consideration is that discarded nanosilver-treated condoms could prevent infecting anyone who finds and touches them.
DATE: 8 November 2012
Researchers found that more than 45 percent of women with HIV may never have been exposed to the most common high-risk forms of the human papillomavirus (HPV). This means that many of these young women can benefit from the HPV vaccine, even if they have already been exposed to HPV.
Jessica Kahn, M.D., of Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, and colleagues analyzed blood and tissue samples from 99 HIV-infected women aged 16 to 23 years, who had received the initial HPV vaccine. They examined the specimens for evidence of existing HPV infection and previous exposure to HPV. The researchers also tested for the presence of 41 of the more than 100 types of HPV-including 13 high-risk types.
Results show that 75 percent of the women had an existing HPV infection with at least one type of HPV virus and 54 percent tested positive for a high-risk type. Nearly half of the women had no existing infection with the two types (HPV-16 and HPV-18) that cause 70 percent of cervical cancers and showed no evidence of exposure to them. When the women received their first HPV vaccination, 12 percent had an existing HPV-16 infection, and 5 percent had an HPV-18 infection. When tested for HPV 16-and HPV-18 individually, nearly 75 percent of women had no current HPV-18 infection and no evidence of exposure. More than half (56 percent) had no current infection or previous exposure to HPV-16. The full report, “Prevalence and Risk Factors for HPV in HIV-Positive Young Women Receiving Their First HPV Vaccination,” was published in the Journal of Acquired Immune Deficiency Syndromes (2012; 61(3):390-399).
DATE: 7 November 2012
With 100 percent of LA County’s precincts reporting, voters approved a measure requiring porn performers to wear condoms while filming sex scenes. Measure B passed 56 percent to 44 percent in the November 6 election. Adult film producers will now be required to apply for a permit from the county Department of Public Health to shoot sex scenes. To enforce compliance, permit fees will finance periodic inspections of film sets. The AIDS Healthcare Foundation sponsored the initiative and declares that the measure will help safeguard the public and the porn workers from sexually transmitted infections. However, the adult film industry, mainly centered in suburban Los Angeles, counters that the requirement is unnecessary, as the industry already polices itself by requiring performers to undergo monthly tests for HIV and other infections.
The adult entertainment industry has subsequently pledged to overturn the measure by suing. The Free Speech Coalition-a trade group representing the adult entertainment industry-explained on November 7 that it plans to file a lawsuit to overturn the condom requirement on the grounds that Measure B is unconstitutional. Diane Duke, the coalition’s executive director, stated that, “The adult film industry will not just stand by and let it destroy our business.” The adult industry representatives also mentioned that they are exploring the idea of moving to neighboring states as soon as possible. The AIDS Healthcare Foundation says the issue is a public health and safety issue, not a free speech issue.
DATE: 16 November 2012
amfAR and AVAC are launching the first in a series of quarterly progress reports on actions taken to accelerate the end of the epidemic. These reports follow the Action Agenda to End AIDS (endingaids.org) our groups issued at the 2012 International AIDS Conference. That document called for specific steps in five critical areas: strategy, investment, accountability, research, and efficiency.
With each issue of the report we aim to ask: Are we following the evidence and making the critical decisions and commitments needed in each area to accelerate progress and begin to end the epidemic? Or are we missing opportunities to act strategically and thereby allowing the epidemic to continue?
For our first update, we hope to pass along what we consider to be key “take-home messages” about results over the past year, including progress under each of the five critical areas and links to relevant materials. We also preview what we will be looking for over the next quarter so that we-and you-can focus on the most important actions needed to lay the foundation for the end of AIDS.
October 25, 2012
As the body ages, changes in the production of hormones occur. The period when a woman’s body begins the transition to menopause is called perimenopause. Women usually enter perimenopause in their 40s and the following changes can occur:
periods become irregular — they become shorter, longer, lighter or heavier some symptoms associated with menopause, such as hot flashes, difficulty falling asleep or staying asleep, vaginal dryness and so on
Most research suggests that HIV-negative women who undergo perimenopause do so without experiencing mood disorders. However, some studies have found that women transitioning toward menopause have an increased risk for depression. This increased risk can occur even among women who have no history of mood disorders such as depression.
A team of researchers in the U.S. enrolled HIV-positive women and women at high risk of HIV infection and found that, regardless of HIV status, women undergoing perimenopause were at increased risk for experiencing symptoms of depression. In turn, the depression experienced by HIV-positive women affected their ability to take potent combination therapy for HIV (commonly called ART or HAART) exactly as directed. The research team encourages doctors and nurses to screen their female HIV-positive patients who are experiencing changes in their monthly cycles for depression and to offer them treatment if it is present…
Persistent fatigue — the feeling of always being tired, even when a person got enough sleep — was one of the most common symptoms associated with HIV early in the epidemic. But how about now? Recent research explored how common and how severe fatigue still is among HIV-positive people…
(11.14.12):: Ronald Valdiserri
Ronald Valdiserri, deputy assistant secretary for Health, Infectious Diseases and director, Office of HIV/AIDS and Infectious Disease Policy at the US Department of Health and Human Services, writes about the 37th Great American Smokeout organized by the American Cancer Society. The purpose of the smokeout is to encourage smokers to use the date to make a plan to quit or to quit on that day. He states that smokers, including those with HIV, will be making an important step toward a healthier life and reducing many health risks.
Valdiserri discusses why smoking is even more harmful for persons living with HIV/AIDS (PLWHA) than the general population. He uses the HRSA Guide for HIV/AIDS Clinical Care, and research to provide evidence that PLWHA should not smoke and should take advantage of the Great American Smokeout to quit. He lists the smoking-related problems in PLWHA, including the normal tobacco-related conditions such as lung cancer and other cancers, as well problems that are specific to PLWHA, such as decreased immunologic and virologic response to antiretroviral therapy, nonadherence to treatment, and a greater chance of being diagnosed with an AIDS-defining condition—or dying of the disease.
Valdiserri emphasizes the role of health care providers in encouraging and supporting PLWHA to quit smoking and references studies that document the importance of clinicians and other HIV service providers’ roles in encouraging smoking cessation and promoting health. To prepare to help patients who are trying to quit smoking, he suggests that HIV providers review the chapter on Smoking Cessation in the Guide for HIV/AIDS Clinical Care (2011), which contains information on behavioral and pharmacological interventions that may be useful. Valdiserri also provides a list of resources for persons who plan to quit smoking or are supporting others to do so.
The term “functional cure” may be new in HIV, but the goal itself is not: In the late 1990s, it was described as “remission,” and scientists have been trying to unlock the secret to it for years. Read about how researchers hope to help people’s immune systems control HIV without having to remain on treatment, and how a group of people dubbed “secondary controllers” may hold a key…