NOTE: Lserv posted at www.RobertMalow.org where you can use the search box to find current and prior Lserv content. Any questions concerning the Lserv (e.g. content that may be valuable to post, literature queries) should be directed to my graduate assistant, Jennifer Attonito at jatto001@fiu.edu. To subscribe or unsubscribe to this HIV Lserv, go to: http://listserv.fiu.edu/archives/hiv.html. Click “Join or Leave HIV.” Enter ‘Name’ and ‘Email Address’ (do not change any of the other settings on this page) then click ‘Join HIV’ button or the “Leave HIV (unsubscribe).
CONTENT
1. HIV and Substance Abuse: A Commentary.
2. Challenges in the Management of HIV-Infected Malnourished Children in Sub-Saharan Africa.
6. Criminal Justice Reform as HIV and TB Prevention in African Prisons.
ARV Treatment Retention, Adherence, Access, Side Effects
10. Antiretroviral prophylaxis for HIV prevention reaches a key milestone
11. Fatal cumulative toxicities of HAART in a stable, AIDS-free, HIV-infected patient.
12. Gender differences in experiences of ART services in South Africa: a mixed methods study.
DRUGS/ALCOHOL/HARM REDUC. RELATED ARTICLE SUMMARIES
20. Mechanism(s) Involved in Opioid Drug Abuse Modulation of HAND.
21. Opiate Drug Use and the Pathophysiology of Neuroaids.
22. Differential Regulation of Neurotoxin in HIV Clades: Role of Cocaine and Methamphetamine.
23. Cocaine and HIV-1 Interplay in CNS: Cellular and Molecular Mechanisms.
24. HIV-1 gp120 and Drugs of Abuse: Interactions in the Central Nervous System.
25. Text Messaging Reduces HIV Risk Behaviors Among Methamphetamine-Using Men Who Have Sex with Men
27. Movement, knowledge, emotion: gay activism and HIV/AIDS in Australia.
29. Stable incidence of HIV diagnoses among Danish MSM despite increased engagement in unsafe sex.
SEXUALLY HIV PREVENTION/PrEP/MICROBICIDE/ CIRCUMCISION RELATED ARTICLE SUMMARIES
33. Sexual Risk Behaviour Among HIV-Positive Persons in Kumasi, Ghana.
36. Human Trafficking Is More Than Sex Trafficking and Prostitution: Implications for Social Work
37. Racial disparities in testing for sexually transmitted infections in the emergency department.
39. Quantifying the Benefits of Link-Tracing Designs for Partnership Network Studies
41. Integrated rapid-diagnostic-test reader platform on a cellphone.
42. Racial Residential Segregation and Rates of Gonorrhea in the United States, 2003-2007.
44. Integrated rapid-diagnostic-test reader platform on a cellphone.
Women/Maternal/Child/Perinatal transmission RELATED ARTICLE SUMMARIES
46. HIV+ women’s narratives of non-disclosure: Resisting the label of immorality.
47. HIV/AIDS, Tuberculosis, and Malaria in Pregnancy.
50. HIV and Hepatitis B Co-infection among Perinatally HIV-infected Thai Adolescents.
51. Age at menopause and menopause-related symptoms in human immunodeficiency virus-infected Thai women.
Clinical/Treatment: ARV/BIOMEDICAL HIV+ CARE/CORMOBIDITIES, TECHNOLOGY RELATED ARTICLE SUMMARIES
56. HIV: A Growing Concern in the Elderly Population.
57. Impact of HIV Severity on Cognitive and Adaptive Functioning During Childhood and Adolescence.
58. HIV Positive Hispanic/Latinos Who Delay HIV Care: Analysis of Multilevel Care Engagement Barriers.
60. Client Satisfaction with HIV Counseling Services: A Cross-Sectional Study from South India.
63. Prevalence of obesity and cardiovascular risk in patients with HIV/AIDS in Porto Alegre, Brazil.
64. Assessing capacity for diagnosing tuberculosis in children in sub-Saharan African HIV care settings
66. Safety of Varenicline Among Smokers Enrolled in the Lung HIV Study.
68. Oliver Mtukudzi’s Musical Approach to HIV/AIDS.
Clinical/Basic Science: HIV+ BIOMED: Immun., Vaccine, Virol., Pathology RELATED ARTICLE SUMMARIES
69. HIV-associated nephropathy: a diagnosis in evolution.
70. International Network for Comparison of HIV Neutralization Assays: The NeutNet Report II.
71. The molecular basis of HIV entry.
72. Improved Outlook on HIV-1 Prevention and Vaccine Development.
74. Nanotechnology and the Treatment of HIV Infection.
76. FDA panel endorses ‘Quad’ pill for HIV
77. FDA panel backs OraSure’s in-home HIV test
78. Taking Truvada to prevent HIV also comes with risks
79. Botswana makes new pitch for circumcision in AIDS fight
80. CDC Proposes that All Baby Boomers Be Tested Once for Hepatitis C
81. AIDS research. FDA panel recommends anti-HIV drug for prevention.
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Misc- Policy, Reviews/MetaAnalyses, Structural/Scale-up/Country Level Translation/Intervention, Economic/Health Disparities, Commentary
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Curr HIV Res. 2012 May 10. [Epub ahead of print]
HIV and Substance Abuse: A Commentary.
Shurtleff D, Lawrence D.
National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD. D. shurtle@mail.nih.gov.
Abstract: http://benthamscience.com/epub.php?JCode=CHIVR
Despite the overall decline in new HIV infections worldwide, infections continue to spread among substance using populations, especially among injection drug abusers (IDU). An estimated 3 million injection drug users worldwide are living with HIV infection nearly 10% of the total estimated number of people living with HIV. In the United States, injection drug users account for approximately 17% of the 1.2 million Americans living with HIV. Moreover, only half of the infected drug users know their HIV status and the number of drug users tested annually for the virus has dropped from 66% in 2006 to 49% in 2009. Against these alarming facts, there is some good news reported by the Centers for Disease Control: Although 1 in 5 injection drug users, in the United States, tested positive for the virus in 1990; that number dropped to 1 in 10 in 2009. This, in part, may be related to the growth of needle exchange programs, which grew from approximately 70 in the 1990s to well over 180 in 2008. However, in Eastern Europe, South America, and East and Southeast Asia, injection drug use is accounting for an increasing proportion of new HIV infections. Furthermore, HIV prevalence among non-injecting drug users has grown to similar levels as IDU, possibly due to high risk sexual behavior associated with use of methamphetamine, amyl nitrates, and cocaine, and/or sexual transmission from IDU to non-IDU drug users. In addition, cigarette smoking among persons living with HIV infection is 2- to 3-fold higher than that of the general population, and multiple studies have identified marijuana and alcohol use in a large proportion of at-risk adolescents and men who have sex with men. Polydrug use is also common in HIV+ populations. Therefore, it is crucial to study the potential impact of substance use on HIV prevention and treatment strategies, HIV pathogenesis, and co-infections, complications and comorbidities associated with HIV infection.
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AIDS Res Treat. 2012;2012:790786. Epub 2012 Mar 1.
Challenges in the Management of HIV-Infected Malnourished Children in Sub-Saharan Africa.
Trehan I, O’Hare BA, Phiri A, Heikens GT.
Department of Paediatrics & Child Health, University of Malawi College of Medicine, Chichiri 3, Blantyre, Malawi.
Free HTML: http://www.hindawi.com/journals/art/2012/790786/
Free PDF: http://downloads.hindawi.com/journals/art/2012/790786.pdf
Abstract: http://www.hindawi.com/journals/art/2012/790786/abs/
Infection with HIV, and oftentimes coinfection with TB, complicates the care of severely malnourished children in sub-Saharan Africa. These superimposed infections challenge clinicians faced with a population of malnourished children for whose care evidence-based guidelines have not kept up. Even as the care of HIV-uninfected malnourished children has improved dramatically with the advent of community-based care and even as there are hopeful signs that the HIV epidemic may be stabilizing or ameliorating, significant gaps remain in the care of malnourished children with HIV. Here we summarize what is currently known, what remains unknown, and what remains challenging about how to treat severely malnourished children with HIV and TB.
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PLoS ONE 7(5): e36172. doi:10.1371/journal.pone.0036172 Published May 16, 2012
Keeping the Faith: African American Faith Leaders’ Perspectives and Recommendations for Reducing Racial Disparities in HIV/AIDS Infection
Amy Nunn , Alexandra Cornwall, Nora Chute, Julia Sanders, Gladys Thomas, George James, Michelle Lally, Stacey Trooskin, Timothy Flanigan amy_nunn@brown.edu
Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, Rhode Island…
Free http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0036172
Abstract
In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia’s most influential African American faith leaders for indepth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia’s racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations’ existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders’ recommendations for tailoring HIV prevention for a faith-based audience.
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AIDS Behav. 2012 May 16. [Epub ahead of print]
Cost-Utility Analysis of the Housing and Health Intervention for Homeless and Unstably Housed Persons Living with HIV.
Holtgrave DR, Wolitski RJ, Pals SL, Aidala A, Kidder DP, Vos D, Royal S, Iruka N, Briddell K, Stall R, Bendixen AV.
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, dholtgra@jhsph.edu.
Abstract/1st page image: http://www.springerlink.com/content/5q8uk78425733073/
We present a cost-utility analysis based on data from the Housing and Health (H&H) Study of rental assistance for homeless and unstably housed persons living with HIV in Baltimore, Chicago and Los Angeles. As-treated analyses found favorable associations of housing with HIV viral load, emergency room use, and perceived stress (an outcome that can be quantitatively linked to quality of life). We combined these outcome data with information on intervention costs to estimate the cost-per-quality-adjusted-life-year (QALY) saved. We estimate that the cost-per-QALY-saved by the HIV-related housing services is $62,493. These services compare favorably (in terms of cost-effectiveness) to other well-accepted medical and public health services.
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Syst Rev. 2012 Feb 16;1(1):13.
Male participation in prevention programmes of mother to child transmission of HIV: a protocol for a systematic review to identify barriers, facilitators and reported interventions.
Morfaw FL, Thabane L, Mbuagbaw LC, Nana PN.
Department of Obstetrics and Gynaecology, Faculty of Medicines and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon. ikomi_fred@yahoo.com.
Free HTML: http://www.systematicreviewsjournal.com/content/1/1/13
Free PDF: http://www.systematicreviewsjournal.com/content/pdf/2046-4053-1-13.pdf
Abstract: http://www.systematicreviewsjournal.com/content/1/1/13/abstract
BACKGROUND: Infection with the HIV and AIDS are leading causes of morbidity and mortality among women and children worldwide. Prevention of mother-to-child transmission of HIV (PMTCT) programs were developed to protect women and their babies from having HIV infection. However, knowledge on how male participation has been applied to these programs is limited. We present a research protocol for a review which seeks to determine the effects of male participation on female uptake of PMTCT programs, and assess how this male participation has been investigated and documented worldwide.
METHODS: This is a systematic review of published literature. We will attempt to identify all studies relevant to the subject written in the English language from January 1998 to June 2011. Electronic searches of the PubMED, EMBASE, CINAHL, and LILACS databases will be conducted using the relevant medical subject headings. Reference lists of identified studies and previous reviews will be manually checked for articles of interest. We shall also contact authors on the field for any relevant material. Two authors (FM and LM) will independently screen potential articles for eligibility using well-defined inclusion and exclusion criteria. They will independently assess the methodological quality of each included paper using the Jadad scale for randomized controlled trials, and the Newcastle-Ottawa scale for observational studies. Then they will independently extract data from the studies using a pre-established data extraction form. The primary outcome data will be female uptake of PMTCT services following a male/couple intervention, while secondary outcome measures will include indicators and barriers of male participation in PMTCT activities among others. During the data extraction process, discrepancies between the two authors will be sorted out by discussion or consultation with a third party (LT). The analysis and reporting of the review will be according to the PRISMA and MOOSE guidelines. Any identified clinical or statistical heterogeneity will be explored. Where possible, a random-effects meta-analysis will be performed to obtain aggregate estimates. We will also assess publication bias using funnel plots. Analysis of other outcomes will be descriptive.
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PLoS Med. 2012 May;9(5):e1001215. Epub 2012 May 8.
Criminal Justice Reform as HIV and TB Prevention in African Prisons.
Todrys KW, Amon JJ.
Human Rights Watch, New York, New York.
Free HTML/Link to Free PDF: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001215
Abstract:
Katherine Todrys and Joseph Amon argue for criminal justice system reforms in sub-Saharan Africa to reduce HIV and TB transmission in prisons and to guarantee detainees’ human rights and health.
Summary Points
- HIV and tuberculosis (TB) prevalence in sub-Saharan Africa is higher in prison than in non-prison populations due, in part, to on-going transmission related to overcrowding and a lack of adequate prevention and treatment services.
- Almost all prisoners eventually leave prison and, along with visitors and prison officers, represent a potential bridge for disease transmission between prison and community populations.
- Thousands of individuals are detained in African prisons unjustly and unnecessarily, including spending long periods in pretrial detention, because of weak criminal justice systems.
- Alleviating overcrowding by increasing the availability of non-custodial alternatives including community service and bail, and improving access to legal representation, are essential public health measures for HIV and TB prevention and control in African prisons.
- African governments and international health donors should fund justice initiatives and other structural interventions to address HIV and TB in prisons
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PLoS One. 2012;7(5):e34749. Epub 2012 May 9.
Allocating Scarce Resources Strategically – An Evaluation and Discussion of the Global Fund’s Pattern of Disbursements.
McCoy D, Kinyua K.
Aidspan, Nairobi, Kenya.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0034749
Abstract:
BACKGROUND: The Global Fund is under pressure to improve its rationing of financial support. This study describes the GF’s pattern of disbursements in relation to total health expenditure (THE), government health expenditure (GHE), income status and the burden of HIV/AIDS, TB and malaria. It also examines the potential for recipient countries to increase domestic public financing for health.
METHODS: This is a cross-sectional study of 104 countries that received Global Fund disbursements in 2009. It analyses data on Global Fund disbursements; health financing indicators; government revenue and expenditure; and burden of disease.
FINDINGS: Global Fund disbursements made up 0.37% of THE across all 104 countries; but with considerable country variation ranging from 0.002% to 53.4%. Global Fund disbursements to government amounted to 0.47% of GHE across the 104 countries, but again with considerable variation (in three countries more than half of GHE was based on Global Fund support). Although the Global Fund provides progressively more funding for lower income countries on average, there is much variation at the country such that here was no correlation between per capita GF disbursements and per capita THE, nor between per capita GF disbursement to government and per capita GHE. There was only a slight positive correlation between per capita GF disbursement and burden of disease. Several countries with a high degree of ‘financial dependency’ upon the Fund have the potential to increase levels of domestic financing for health.
DISCUSSION: The Global Fund can improve its targeting of resources so that it better matches the pattern of global need. To do this it needs to: a) reduce the extent to which funds are allocated on a demand-driven basis; and b) align its funding model to broader health systems financing and patterns of health expenditure beyond the three diseases.
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ARV Treatment Retention, Adherence, Access, Side Effects
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AIDS Behav. 2012 May 15. [Epub ahead of print]
Adherence to Antiretroviral Therapy and Acceptability of Planned Treatment Interruptions in HIV-Infected Children.
Harrison L, Ananworanich J, Hamadache D, Compagnucci A, Penazzato M, Bunupuradah T, Mazza A, Ramos JT, Flynn J, Rampon O, Mellado Pena MJ, Floret D, Marczynska M, Puga A, Forcat S, Riault Y, Lallemant M, Castro H, Gibb DM, Giaquinto C; On Behalf of the Paediatric European Network for Treatment of AIDS (PENTA) 11 Trial Team.
Medical Research Council Clinical Trials Unit, Aviation House, London, UK.
Free HTML: http://www.springerlink.com/content/m674137318028711/fulltext.html
Free PDF: http://www.springerlink.com/content/m674137318028711/fulltext.pdf
Abstract: http://www.springerlink.com/content/m674137318028711/
There have been no paediatric randomised trials describing the effect of planned treatment interruptions (PTIs) of antiretroviral therapy (ART) on adherence, or evaluating acceptability of such a strategy. In PENTA 11, HIV-infected children were randomised to CD4-guided PTIs (n = 53) or continuous therapy (CT, n = 56). Carers, and children if appropriate, completed questionnaires on adherence to ART and acceptability of PTIs. There was no difference in reported adherence on ART between CT and PTI groups; non-adherence (reporting missed doses over the last 3 days or marking <100 % adherence since the last clinical visit on a visual analogue scale) was 18 % (20/111) and 14 % (12/83) on carer questionnaires in the CT and PTI groups respectively (odds ratios, OR (95 % CI) = 1.04 (0.20, 5.41), χ(2) (1) = 0.003, p = 0.96). Carers in Europe/USA reported non-adherence more often (31/121, 26 %) than in Thailand (1/73, 1 %; OR (95 % CI) = 54.65 (3.68, 810.55), χ(2) (1) = 8.45, p = 0.004). The majority of families indicated they were happy to have further PTIs (carer: 23/36, 64 %; children: 8/13, 62 %), however many reported more clinic visits during PTI were a problem (carer: 15/36, 42 %; children: 6/12, 50 %).
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PLoS One. 2012;7(5):e36737. Epub 2012 May 9.
Multiple Measures Reveal Antiretroviral Adherence Successes and Challenges in HIV-Infected Ugandan Children.
Haberer JE, Kiwanuka J, Nansera D, Ragland K, Mellins C, Bangsberg DR.
Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0036737
Abstract:
BACKGROUND: Adherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood.
METHODOLOGY/PRINCIPAL FINDINGS: To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2-10 years for one year. Median adherence levels were 100% by three-day recall, 97.4% by 30-day visual analog scale, 97.3% by unannounced pill count/liquid formulation weights, and 96.3% by medication event monitors (MEMS). Interruptions in MEMS adherence of ≥48 hours were seen in 57.0% of children; 36.3% had detectable HIV RNA at one year. Only MEMS correlated significantly with HIV RNA levels (r=-0.25, p=0.04). Multivariable regression found the following to be associated with <90% MEMS adherence: hospitalization of child (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.6-5.5; p= 0.001), liquid formulation use (AOR 1.4, 95%CI 1.0-2.0; p=0.04), and caregiver’s alcohol use (AOR 3.1, 95%CI 1.8-5.2; p<0.0001). Child’s use of co-trimoxazole (AOR 0.5, 95%CI 0.4-0.9; p=0.009), caregiver’s use of ART (AOR 0.6, 95%CI 0.4-0.9; p=0.03), possible caregiver depression (AOR 0.6, 95%CI 0.4-0.8; p=0.001), and caregiver feeling ashamed of child’s HIV status (AOR 0.5, 95%CI 0.3-0.6; p<0.0001) were protective against <90% MEMS adherence. Change in drug manufacturer (AOR 4.1, 95%CI 1.5-11.5; p= 0.009) and caregiver’s alcohol use (AOR 5.5, 95%CI 2.8-10.7; p<0.0001) were associated with ≥48-hour interruptions by MEMS, while second-line ART (AOR 0.3, 95%CI 0.1-0.99; p= 0.049) and increasing assets (AOR 0.7, 95%CI 0.6-0.9; p=0.0007) were protective against these interruptions.
CONCLUSIONS/SIGNIFICANCE: Adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for the child to adhere. Further research is needed to better understand and build on these key influential factors for adherence intervention development.
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Antiretroviral prophylaxis for HIV prevention reaches a key milestone
Lancet. 18 May 2012
Abdool Karim SS, Abdool Karim Q
On May 10, 2012, a US Food and Drug Administration (FDA) advisory committee voted in support of the use of tenofovir-emtricitabine for HIV prevention. If the FDA, which is scheduled to make its decision by June 15, adopts the committee’s recommendations, tenofovir-emtricitabine will become the first antiretroviral drug to be approved as pre-exposure prophylaxis (PrEP) for the prevention of HIV, paving the way for implementation. PrEP has a unique advantage in young women in southern Africa, who bear a disproportionate burden of the HIV epidemic. In much of this region, young women are often unable to convince their male partners to use condoms, remain faithful, or have an HIV test. To rely on her HIV-positive discordant male partner to come forward to test, to agree to take antiretroviral therapy (ART), and to take his ART with high adherence, all for her protection, puts a woman’s risk of acquiring HIV back in the hands of men, thereby disempowering women and undermining their efforts to control their risk of HIV.
However, there are several criticisms and concerns about PrEP. First, that data on the effectiveness of PrEP, especially in women, are inconsistent… Second, some suggest that antiretroviral drugs should be provided to HIV-negative people only when all eligible HIV-positive patients are receiving ART… Third, there is a fear that PrEP will lead to worsening of the HIV epidemic, since PrEP users might reduce their use of higher-efficacy HIV prevention strategies such as condoms… Fourth, could PrEP undermine future AIDS treatment by causing drug resistance? The risk of drug resistance from PrEP is very different from that noted when, for example, nevirapine is given to HIV-positive pregnant women, since those taking PrEP generally do not have circulating virus which can become drug-resistant… The main issue in resistance is whether this will compromise their antiretroviral treatment options in several years’ time when they might require ART. At present, there are no data to answer this question. Finally, some claim that PrEP is unaffordable…
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BMJ Case Rep. 2012 Mar 8;2012. pii: bcr1020114905.
Fatal cumulative toxicities of HAART in a stable, AIDS-free, HIV-infected patient.
Saison J, Cotte L, Chidiac C, Ferry T.
Hospices Civils de Lyon, Service de Maladies Infectieuses et Tropicales, Lyon, France.
The authors describe the case of fatal cumulative toxicities in a 58-year-old AIDS-free, HIV-infected patient, who successively developed under highly active antiretroviral therapy (HAART): severe lipodystrophy, complicated osteoporosis, complicated non-cirrhotic portal hypertension of the liver (with ascites, portal thrombosis, oesophageal varices and protein-losing enteropathy) due to nodular regenerative hyperplasia. These cumulative HAART-related toxicities led to death, despite symptomatic treatment and the switch of antiretrovirals (especially didanosine) putatively involved in the process in these drug-mediated diseases. As morbidity and mortality in HIV infection continue to improve, it appears important to recognise such rare HAART-associated toxicities. This case illustrates the absolute necessity of investigating the long-term side effects of HAART in HIV infection, particularly in patients treated with first generation molecules. The switch strategy (switching old molecules to newer ones) is crucial in case of severe suspected toxicity and has to be discussed in asymptomatic patients largely exposed to first generation molecules, in order to prevent long-term toxicity.
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Trop Med Int Health. 2012 May 18.. [Epub ahead of print]
Gender differences in experiences of ART services in South Africa: a mixed methods study.
Schneider H, Govender V, Harris B, Cleary S, Moshabela M, Birch S.
University of the Western Cape, Cape Town, South Africa; University of Cape Town, Cape Town, South Africa; University of Witwatersrand, Johannesburg, South Africa Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.
Objectives: A mixed methods study exploring gender differences in patient profiles and experiences of ART services, along the access dimensions of availability, affordability and acceptability, in two rural and two urban areas of South Africa.
Methods: Structured exit interviews (n=1266) combined with in-depth interviews (n=20) of women and men enrolled in ART care.
Results: Men attending ART services were more likely to be employed (29%vs. 20%, P=0.001) and were twice as likely to be married/co-habiting as women (42%vs. 22%P=0.001). Men had known their HIV status for a shorter time (mean 32 vs. 36 months, P=0.021) and were also less likely to disclose their status to non-family members (17%vs. 26%, P=0.001). From both forms of data collection, a key finding was the role of female partners in providing social support and facilitating use of services by men. The converse was true for women who relied more on extended families and friends than on partners for support. Young, unmarried and unemployed men faced the greatest social isolation and difficulty. There were no major gender differences in the health system (supply side) dimensions of access.
Conclusions: Gender differences in experiences of HIV services relate more to social than health system factors. However, the health system could be more responsive by designing services in ways that enable earlier and easier use by men.
Pan Afr Med J. 2012;11:39. Epub 2012 Mar 7.
A pharmacovigilance study of adults on highly active antiretroviral therapy, South Africa: 2007 – 2011.
Dube NM, Summers R, Tint KS, Mayayise G.
School of Health Sciences and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa.
Free PDF: http://www.panafrican-med-journal.com/content/article/11/39/pdf/39.pdf
Abstract: http://www.panafrican-med-journal.com/content/article/11/39/abstract/
BACKGROUND: Of the 1.6 million South African people infected with human immunodeficiency virus (HIV), approximately 970,000 (55%) have been initiated on HAART. Despite these numbers, very little has been published about the safety profile of antiretroviral (ARV) medicines in the country. This study was performed at the Medunsa National Pharmacovigilance Centre and aimed to describe the demographic characteristics of patients enrolled in the pharmacovigilance surveillance study; highly active antiretroviral therapy (HAART) initiation regimen patterns; reasons for regimen changes; and adverse effects of ARV medicines.
METHODS: A cohort study of HIV-infected individuals aged 15 years or older who were on ARV medicines was conducted at four sentinel sites.
RESULTS: After HAART initiation, with an average lapse of 17.8 months (range: 0 – 83.8 months), 2,815 patients were enrolled into the study. Results show that patients were observed for 1,606.2 person-years for pharmacy visits (collection of ARV medicines) and 817.1 person-years for clinical visits (consultation with the doctor). Females constituted 69.6% (1,958/2,815) of the study population. Almost all patients initiated HAART on first-line regimens (2,801/2,815). Some patients (6.7%, 190/2,815) dropped out of the study after HAART initiation. Reasons for regimen changes were not recorded for 2.5% (22/891) of the patients who changed regimens. The primary reason for regimen changes was drug-related toxicity (76.1%, 678/891), mostly evident in patients taking first-line regimens. Adverse effects experienced by patients were polyneuropathy (24.0%, 163/678); lipodystrophy (23.9%, 162/678); neuropathy (10.6%, 72/678); and suspected lactic acidosis (3.8%, 26/678).
CONCLUSION: The majority of prescribers complied with the HAART guidelines and initiated most patients on first-line regimens. However, adverse effects are evident in patients taking first-line regimens. We recommend that the Department of Health should introduce less toxic first-line ARV regimens. Future efforts will aim to initiate patients on HAART and enrol them into the study simultaneously to determine early risk profiles of ARV medicines.
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HIV Clin Trials. 2012 May 1;13(3):131-141.
Response to Combined Antiretroviral Therapy According to Gender and Origin in a Cohort of Naïve HIV-Infected Patients: GESIDA-5808 Study.
Pérez-Molina JA, Mora Rillo M, Suárez-Lozano I, Casado-Osorio JL, Teira Cobo R, Rivas González P, Pedrol Clotet E, Hernando-Jerez A, Domingo P, Barquilla Díaz E, Esteban H, González-García J, For The Gesida 5808 Study Group.
Tropical Medicine, Infectious Diseases Department, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
Abstract: http://thomasland.metapress.com/content/0g465750u5131856/
Background: We analyzed differences in response to combined antiretroviral therapy (cART) according to sex and geographic origin in a retrospective comparative study of Spanish-born and immigrant patients initiating cART.
Methods: The primary endpoint was time to treatment failure (TTF), defined as virological failure, death, opportunistic infection, interruption of cART, or loss to follow-up. Late diagnosis was defined as a CD4+ cell count ≤ 200 cells/mm3 and/or AIDS at initiation of cART. Survival was analyzed using Kaplan-Meier analysis and Cox regression.
Results: We followed 1,090 patients, of whom 318 were women (45.6% immigrant women [IW]). At initiation of treatment, women had a higher CD4+ count than men (217 vs 190 cells/mm3), a lower viral load (4.7 vs 5 log), and fewer were late starters (49% vs 59%). The adjusted risk of TTF between women and men was not significantly different (hazard ratio [HR], 1.10; 95% CI, 0.79-1.53). TTF was shorter among IW than Spanish-born women (124 weeks [95% CI, 64-183] vs 151 [95% CI, 127-174]) and loss to follow-up was double that of Spanish-born women (25.5% vs 11.6%).
Conclusions: Although response to cART was similar for both sexes, men started treatment later. IW were more frequently lost to follow-up and switched treatment. Measures to improve medical follow-up after initiation of cART should be promoted among this minority group.
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Curr HIV Res. 2012 May 10. [Epub ahead of print]
Response to Antiretroviral Treatment After Failure of NNRTI plus NRTIs-Based Therapy. Data from the ARCA Collaborative Group.
Seminari E, De Silvestri A, Meini G, Callegaro A, Boeri E, Punzi G, Gianotti N, Bruzzone B, Tinelli C, Grossi P.
Clinica di Malattie Infettive e Tropicali, Ospedale di Circolo, Varese, Italy. elenaseminari@yahoo.com.
Abstract: http://benthamscience.com/epub.php?JCode=CHIVR
Objective: The aim of the present study was to evaluate the virological response to a new antiretroviral treatment (ART2) after failure of a nonnucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs)-containing regimen.
Design: Retrospective observational study based on the Italian ARCA cohort database. Adult patients were included if they had a virological failure (defined as plasma viral load above 500 copies/ml in two subsequent visits) while on a treatment with one NNRTI plus 2 NRTIs, had an available HIV genotype.
Results: Patients on ART2 were followed up for 791 person/year and median follow up was 10.8 months(IQR 5.2-26). Variables associated with reduced risk of ART2 virological failure at univariable analysis had started the treatment in recent years (HR 0.90; 95% CI 0.86-0.94, p<0.0001) and duration of previous NNRTI treatment (HR 0.995; 95%CI 0.990-0.990, p=0.045). Variables associated with increased risk of virological failure of ART2 were a higher plasma viral load (pVL) at baseline(HR 1.2; 95% CI 1.07-1.34, p=0.002) and the type of treatment, in particular an unboosted PIcontaining regimen vs. a boosted PI-containing regimen(HR 1.6; 95%CI 1.25-2.04 p<0.0001) and a nonPI-containing vs. a boosted PI-containing regimen (HR 1.56; 95% CI 1.25-1.96, p<0.0001). At multivariable analysis, year of ART2 start, pVL at NNRTI failure as well as using a boosted PI remained statistically significant predictors.
Conclusion: This study highlights the role of drugs with high genetic barrier, such as boosted PI as a cornerstone to build a new antiretroviral treatment in patients failing a NNRTI based regimen.
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Pediatr Infect Dis J. 2012 May 10. [Epub ahead of print]
Prospective Long-Term Outcomes of a Cohort of Ugandan Children with Laboratory Monitoring During Antiretroviral Therapy.
Kekitiinwa A, Asiimwe AR, Kasirye P, Korutaro V, Kitaka S, Maganda A, Madalon M, Graziano FM.
Baylor College of Medicine Bristol Myers Squibb Children’s Clinical Centre of Excellence, Mulago Hospital Kampala, Uganda; The University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
BACKGROUND: Treatment of HIV-1 infected Ugandan children with ART is increasing but few prospective long-term studies evaluating the treatment process have been reported. In this study we sought to determine prospectively how consistent monitoring of HIV-1 RNA levels impacts the ART treatment process.
METHODS: One hundred and eight children initiating ART were enrolled into this study. These children had comprehensive laboratory monitoring including HIV-1 RNA level determination and genotype analysis (where appropriate), CD4 % plus absolute counts, and safety laboratory measurements performed prior to starting therapy and at regular intervals after receiving ART. Kaplan-Meier statistics were used to examine predictors of survival and virologic failure. Viral genotype analysis was performed on samples obtained from children having virologic failure to determine the emergence of mutations.
RESULTS: Clinically, there was no difference in the three year survival between our cohort receiving consistent laboratory monitoring and a matched historical clinic cohort not routinely receiving laboratory monitoring. However, 34% of children receiving ART demonstrated virologic failure. Eleven of these children received second line ART and all responded with an undetectable HIV-1 RNA level and increase in CD4 count. Children remaining on a failing antiretroviral regimen accumulated resistance mutations.
CONCLUSIONS: Our prospective long-term findings support the general use of monitoring HIV-1 RNA levels for management of children on ART and the adoption of a clearer definition for virologic failure and better guidelines for managing children with unsuppressed HIV-1 RNA levels.
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DRUGS/ALCOHOL/HARM REDUC. RELATED ARTICLE SUMMARIES
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Curr HIV Res. 2012 May 10. [Epub ahead of print]
Effectiveness of Antiretroviral Therapy in HIV-1-Infected Active Drug Users Attended in a Drug Abuse Outpatient Treatment Facility Providing a Multidisciplinary Care Strategy.
Sánchez GV, Llibre JM, Torrens M, Sanvisens A, Mateu G, Knobel H, Langohr K, Santos JR, Muga R.
Department of Internal Medicine, Hospital del Mar, Barcelona, Spain. 91773@parcdesalutmar.cat.
Abstract: http://benthamscience.com/epub.php?JCode=CHIVR
Objective: HIV-1-infected active drug users (ADU) obtain smaller clinical benefits with antiretroviral therapy (HAART) compared to non-ADU subjects with sexually-transmitted HIV-1 infection. Therefore treatment strategies are required to address the specific issues arising in this challenging scenario. We describe the effectiveness of HAART provided in a drug abuse outpatient treatment facility through a comprehensive integrated care that includes medical, drug dependence, and psychosocial support.
Methods: We included all consecutive HIV-1-infected ADU admitted for drug dependency treatment and who started their first HAART. A comparator arm consisted of a control group of sexually transmitted HIV-1-infected subjects attended in a reference hospital under standard care. The strategy did not include directly observed treatment.
Results: A total of 71 ADU and 48 matched subjects infected through sexual transmission were included. ADU had lower baseline CD4+ T-cell counts (196 vs 279 cells/μL, P=.001), and more advanced CDC stages (P=.001). The estimated probabilities of patients with virological response (<50 copies/mL) at weeks 48 and 96 were 92.9% (95%-CI: 87.1%-99.1%) and 87.3% (95%-CI: 78.7%-95.2% for ADU, and 93.7%(95%-CI: 84.1%-99.8%) and 87.5% % (95%-CI: 77.5%-97.3%) for sexually-infected subjects (P= .1325 and .241). Kaplan-Meier estimates of time to loss of virological response did not show differences between groups (log rank test, P=.965).
Conclusions: An integrated multidisciplinary care of HIV-1-infected antiretroviral naïve ADU provided in a drug abuse treatment center obtains high rates of virological suppression, similar to those observed in a comparison group of sexually-transmitted HIV-1-infected subjects. This strategy should be further evaluated in public health programs and assessed in randomized trials.
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Harm Reduct J. 2012 May 16;9(1):17. [Epub ahead of print]
Harmonizing disease prevention and police practice in the implementation of HIV prevention programs: Up-stream strategies from Wilmington, Delaware.
Silverman B, Davis CS, Graff J, Bhatti U, Santos M, Beletsky L.
Free PDF: http://www.harmreductionjournal.com/content/pdf/1477-7517-9-17.pdf
Abstract: http://www.harmreductionjournal.com/content/9/1/17/abstract
INTRODUCTION: Improving access to sterile injection equipment is a key component in community-based infectious disease prevention. Implementation of syringe access programs has sometimes been complicated by community opposition and police interference. Case description In 2006, the Delaware legislature authorized a pilot syringe exchange program (SEP). A program designed to prevent, monitor, and respond to possible policing and community barriers before they had a chance to effect program implementation and operation . was planned and implemented by a multidisciplinary team of legal practitioners and public health professionals.
DISCUSSION: We report on an integrated intervention to address structural barriers to syringe exchange program utilization. This intervention employs community, police and client education combined with systematic surveillance of and rapid response to police interference to preempt the kinds of structural barriers to implementation observed elsewhere. The intervention addresses community concerns and stresses the benefits of syringe exchange programs to officer occupational safety.
CONCLUSIONS: A cohesive effort combining collaboration with and educational outreach to police and community members based on the needs and concerns of these groups as well as SEP clients and potential clients helped establish a supportive street environment for the SEP. Police-driven structural barriers to implementation of public health programs targeting populations engaged in drug use and other illicit behavior can be addressed by up-stream planning, prevention, monitoring and intervention strategies. More research is needed to inform the tailoring of interventions to address police-driven barriers to HIV prevention services, especially among marginalized populations.
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The Influence of Marijuana and Alcohol Use on Condom Use Behavior: Findings From a Sample of Young Adult Female Bar Drinkers.
Parks, Kathleen A.; Collins, R. Lorraine; Derrick, Jaye L.
Psychology of Addictive Behaviors, May 21 , 2012,
Abstract http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2012-13118-001
Prevalence data indicate that alcohol and marijuana are frequently used intoxicants among young adults in the United States. In a number of studies, both alcohol use and marijuana use have been associated with failure to use condoms, a high-risk sexual behavior. The purpose of the current study was to assess the individual and additive effects of alcohol and marijuana use on this risky sexual behavior among 251 young adult, female bar drinkers. Multilevel modeling was used to assess the likelihood of condom use during sexual events that occurred as a function of substance use (none, only alcohol, only marijuana, or both) prior to and partner type (known or casual) during the event, as well as individual differences in sexual assertiveness. Initial model testing (Levels 1 and 2) revealed that there were significant main effects for partner type (known), substance use (alcohol and marijuana) and sexual assertiveness (refusal, pregnancy/STI prevention) on risky sex. Final model testing indicated that sexual assertiveness interacted with substance use to influence risky sex. Women who were low in sexual assertiveness refusal were more likely to engage in risky sex on days when they had consumed both alcohol and marijuana prior to the sexual activity. These findings highlight the complex nature of the relationship between substance use and risky sex.
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Curr HIV Res. 2012 May 11. [Epub ahead of print]
Mechanism(s) Involved in Opioid Drug Abuse Modulation of HAND.
Dutta R, Roy S.
Division of Infection Inflammation and Vascular Biology, Department of Surgery and Pharmacology, University of Minnesota, Minneapolis, MN. royxx002@umn.edu.
Abstract: http://benthamscience.com/epub.php?JCode=CHIVR
Drug abuse and HIV infection are interlinked. From the onset of the HIV/AIDS epidemic, the impact of illicit drug use on HIV disease progression has been a focus of many investigations. Both laboratory-based and epidemiological studies strongly indicate that drug abuse may exacerbate HIV disease progression and increase mortality and morbidity in these patients. Increase susceptibility to opportunistic infection has been implicated as one of the major cause for this detriment. Furthermore, opioids are known to elicit prevalence of neurodegenerative disorders in HIV-infected patients. Numerous authors have delineated various molecular as well as cellular mechanisms associated with neurological complications in these patients. This review gives an overview of these findings. Understanding the mechanisms will allow for the development of targeted therapies aimed at reducing the progression of neurocognitive decline in the drug abusing HIV infected individuals.
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Curr HIV Res. 2012 May 11. [Epub ahead of print]
Opiate Drug Use and the Pathophysiology of Neuroaids.
Fitting S, Dever SM, Podhaizer EM, Knapp PE, Hauser KF.
Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, Virginia kfhauser@vcu.edu.
Abstract: http://benthamscience.com/epub.php?JCode=CHIVR
Opiate abuse and HIV-1 have been described as interrelated epidemics, and even in the advent of combined anti-retroviral therapy, the additional abuse of opiates appears to result in greater neurologic and cognitive deficits. The central nervous system is particularly vulnerable to interactive opiate-HIV-1 effects, in part because of the unique responses of microglia and astroglia. Although neurons are principally responsible for behavior and cognition, HIV-1 infection and replication in the brain is largely limited to microglia, while astroglia and perhaps glial progenitors can be latently infected. Thus, neuronal dysfunction and injury result from cellular and viral toxins originating from HIV-1 infected/exposed glia. Importantly, subsets of glial cells, as well as neurons, expressμ-opioid receptors and therefore can be direct targets for heroin and morphine (the major metabolite of heroin in the CNS), which preferentially activate μ-opioid receptors. This review highlights findings that neuroAIDS is a glially driven disease, and that opiate abuse may act at multiple glial-cell types to further compromise neuron function and survival. The ongoing, reactive cross-talk between opiate drug and HIV-1 co-exposed microglia and astroglia appears to exacerbate critical proinflammatory and excitotoxic events leading to neuron dysfunction, injury, and potentially death. Opiates enhance synaptodendritic damage and a loss in synaptic connectivity in neurons, which is viewed as the substrate of cognitive deficits. We especially emphasize that opioid signaling and interactions with HIV-1 are contextual, differing among cell types, and even within subsets of the same cell type. For example, astroglia even within a single brain region are heterogeneous in their expression of μ-, δ-, and κ-opioid receptors, as well as CXCR4 and CCR5, and Toll-like receptors. Thus, defining the distinct targets engaged by opiates in each cell type, and among brain regions, is critical to an understanding of how opiate abuse exacerbates neuroAIDS.
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Curr HIV Res. 2012 May 11. [Epub ahead of print]
Differential Regulation of Neurotoxin in HIV Clades: Role of Cocaine and Methamphetamine.
Nair MP, Samikkannu T.
College of Medicine, University Park, Miami, FL. nairm@fiu.edu.
Abstract: http://benthamscience.com/epub.php?JCode=CHIVR
Studies have demonstrated that infection with HIV-1 (subtypes) clades might differentially contribute to HIV-1-associated neuro cognitive disorder (HAND). Substance abuse and illicit drugs such as cocaine and methamphetamine (METH) are also known to play a role in neuronal impairments. Neurotoxin quinolinic acid (QUIN) and arachidonic acid (AA) metabolites are regulators of central nervous system (CNS) functions. These neurotoxins are dysregulated during HIV infection and substance abuse exacerbates immune and neuronal dysfunctions, leading to dementia and neurocognitive impairments. Studies have demonstrated an association between HIV infection and substance abuse in terms of viral replication and disease progression in Neuro- AIDS. In this review, we briefly discuss the effect of cocaine and METH, and differential role of HIV-1 B and C induced indoleamine-2, 3-dioxygenase (IDO) and cyclooxygenase-2 (COX-2) mediated induction of neurotoxin QUIN and AA metabolites that implicate neuronal dysfunctions.
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Curr HIV Res. 2012 May 11. [Epub ahead of print]
Cocaine and HIV-1 Interplay in CNS: Cellular and Molecular Mechanisms.
Buch S, Yao H, Guo M, Mori T, Seth P, Wang J, Su TP.
Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE. sbuch@unmc.edu.
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/22591366.1
Although antiretrovirals are the mainstay of therapy against HIV infection, neurological complications associated with the virus continue to hamper quality of life of the infected individuals. Adding complexity to this mix is the use of illicit drugs by the infected individuals, which further fuels the epidemic. Epidemiological studies on drug abusers with AIDS link abuse of cocaine, even more than other drugs, to increased incidence of HIV seroprevalence and progression to AIDS. Cell culture as well as animal studies have demonstrated that cocaine can not only potentiate HIV-1 replication but can also co-operate with HIV proteins to enhance glial cell activation, neurotoxicity, and breakdown of the blood-brain barrier. In addition, based on the ability of HIV proteins and cocaine to modulate NMDA receptor expression on neurons, NMDA receptors have been suggested as a common link underlying the crosstalk between drug addiction and HIV infection. Affinity of cocaine for sigma receptor is also a mechanism by which the drug induces signaling in various cell types of the CNS. In this review, recent findings on the interplay of HIV infection and cocaine abuse and their possible implications in mode of action and/or addiction will be discussed.
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Curr HIV Res. 2012 May 10. [Epub ahead of print]
HIV-1 gp120 and Drugs of Abuse: Interactions in the Central Nervous System.
Silverstein PS, Shah A, Weemhoff J, Kumar S, Singh DP, Kumar A.
Department of Pharmacology and Toxicology, School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO. silversteinp@umkc.edu.
Abstract: http://benthamscience.com/epub.php?JCode=CHIVR
HIV-1 infection is a global public health problem with more than 33 million people living with HIV infection. Although great strides have been made in treating this epidemic with therapeutic agents, the increase in patient life span has been coincident with an increase in the prevalence of HIV-associated neurocognitive disorders (HAND). HAND is thought to result from the neurotoxic effects of viral proteins that are shed from HIV-infected microglial cells. One of the primary neurotoxins responsible for this effect is the HIV-1 glycoprotein gp120. Exposure of neurons to gp120 has been demonstrated to cause apoptosis in neurons, as well as numerous indirect effects such as an increase in inflammatory cytokines, an increase in oxidative stress, and an increase in permeability of the blood-brain barrier. In many patients, the use of drugs of abuse (DOA) exacerbates the neurotoxic effects of gp120. Cocaine, methamphetamine and morphine are three DOAs that are commonly used by those infected with HIV-1. All three of these DOAs have been demonstrated to increase oxidative stress in the CNS as well as to increase permeability of the blood-brain barrier. Numerous model systems have demonstrated that these DOAs have the capability of exacerbating the neurotoxic effects of gp120. This review will summarize the neurotoxic effects of gp120, the deleterious effects of cocaine, methamphetamine and morphine on the CNS, and the combined effects of gp120 in the context of these drugs.
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MSM RELATED ARTICLE SUMMARIES
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AIDS and Behavior, online 1st May 19, 2012
Text Messaging Reduces HIV Risk Behaviors Among Methamphetamine-Using Men Who Have Sex with Men
Cathy J. Reback, Deborah Ling Grant, Jesse B. Fletcher, Catherine M. Branson, Steven Shoptaw, Jane Rohde Bowers, Mahnaz Charania and Gordon Mansergh
Abstract/1st page image http://www.springerlink.com/content/n7274k3421423712/
Text-messaging interventions present a novel approach for targeting high-risk men who have sex with men (MSM) who may not respond to or may be difficult to reach for face-to-face or site-based interventions. Project Tech Support (N = 52) was an open label pilot study testing the feasibility and utility of a text-messaging intervention to reduce methamphetamine use and high-risk sexual behaviors among out-of-treatment MSM. Participants in the two-week intervention received social support and health education text messages transmitted in real-time. At follow-up, there were significant decreases in frequency of methamphetamine use and unprotected sex while on methamphetamine (both p < 0.01), and a significant increase in self-reported abstinence from methamphetamine use (13.3 % vs. 48.9 %; p < 0.001). Additionally, participants reported reductions of unprotected anal intercourse with HIV-positive partners (p < 0.01); with HIV-negative partners, participants reported fewer insertive and receptive episodes (both p < 0.05). Findings demonstrate that text messaging is a promising intervention for reaching and potentially changing HIV high-risk behaviors among out-of-treatment, methamphetamine-using MSM.
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AIDS and Behavior, online 1st May 19, 2012
Assessing Priorities for Combination HIV Prevention Research for Men Who have Sex with Men (MSM) in Africa
Stefan Baral, Andrew Scheibe, Patrick Sullivan, Gift Trapence, Andrew Lambert, Linda-Gail Bekker and Chris Beyrer
Abstract/1st page image http://www.springerlink.com/content/6n2v71142345hpk1/
A consultation was hosted in South Africa (March 2011) to assess the combination HIV prevention research priorities of academics, implementers and MSM community leaders. Sixty-nine participants, representing 17 African countries, participated. Interactive strategies were used to present current data on HIV interventions and discussions on research possibilities were facilitated with research priorities identified using the nominal group technique. Data were analysed using directed content analysis. Health worker training, social mobilisation, and community engagement were prioritised as structural interventions. Comprehensive counselling was identified as the most important behavioural intervention, with adherence, mental health, and risk reduction counselling identified as key counselling topics. Rectal microbicides, oral pre-exposure prophylaxis and condom and lubricant distribution were the most important biomedical interventions. This consultation resulted in the first combination HIV prevention research agenda for MSM in Africa. Outcomes will inform future research and be used to advocate for combination approaches to HIV prevention for MSM.
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Cult Health Sex. 2012 May 16. [Epub ahead of print]
Movement, knowledge, emotion: gay activism and HIV/AIDS in Australia.
Buchanan D.
Forbes Chambers , Sydney , Australia E-mail: dbuchanan@forbeschambers.com.au.
Book Review 1st page image: http://www.tandfonline.com/doi/abs/10.1080/13691058.2012.680265?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
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J Acquir Immune Defic Syndr. 2012 May 15. [Epub ahead of print]
Sexual frequency and planning among at-risk men who have sex with men (MSM) in the US: implications for event-based intermittent pre-exposure prophylaxis (iPrEP).
Volk JE, Liu A, Vittinghoff E, Irvin R, Kroboth E, Krakower D, Mimiaga MJ, Mayer KH, Sullivan PS, Buchbinder S.
1HIV Research Section, Department of Public Health, San Francisco, CA, United States 2University of California, San Francisco, CA, United States 3Center for AIDS Prevention Studies, San Francisco, CA, United States 4Harvard Medical School/Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, MA, United States 5Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States 6Harvard School of Public Health, Department of Epidemiology, Boston, MA, United States 7The Fenway Institute, Fenway Health, Boston, MA, United States 8Emory University, Atlanta, GA, United States.
Intermittent dosing of pre-exposure prophylaxis (iPrEP) has potential to decrease costs, improve adherence, and minimize toxicity. Practical event-based dosing of iPrEP requires men who have sex with men (MSM) to be sexually active on fewer than 3 days each week and plan for sexual activity. MSM who may be most suitable for event-based dosing were older, more educated, more frequently used sexual networking websites, and more often reported that their last sexual encounter was not with a committed partner. A substantial proportion of these MSM endorse high-risk sexual activity, and event-based iPrEP may best target this population.
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J Acquir Immune Defic Syndr. 2012 May 15. [Epub ahead of print]
Stable incidence of HIV diagnoses among Danish MSM despite increased engagement in unsafe sex.
Cowan SA, Gerstoft J, Haff J, Hartvig Christiansen A, Statistician JN, Obel2 N.
Statens Serum Institut, Artillerivej, Copenhagen S, Denmark; Copenhagen University Hospital, Rigshospitalet, Blegdamsvej, Copenhagen, Denmark; STOP AIDS – Gay Men’s HIV Organization, Amagertorv, Copenhagen K, Denmark.
BACKGROUND: Since introduction of highly active antiretroviral therapy (HAART) the prevalence of Danish HIV-positive men who have sex with men (MSM) has increased substantially. In contrast the incidence of MSM diagnosed with HIV has not increased and this paradox has been the focus of intensive debate.
METHODS: Study period was 1995-2010. Data were obtained from two Danish nationwide registries of HIV and syphilis, and five consecutive surveys on sexual behavior in Danish MSM. We calculated incidences of HIV and syphilis in MSM, prevalence of HIV positive MSM with detectable viral load (>400 HIV-RNA copies/ml), and changes in frequency of unprotected anal intercourse (UAI). We introduce The Cohort Community Reproductive Rate (CCRR) to describe the number of newly diagnosed MSM per HIV-positive MSM per year and used Poisson regression to model CCRR.
RESULTS: From 1995-2010 the prevalence of Danish MSM diagnosed with HIV increased from 1,035 to 1,813 (75%), while the number of HIV-positive MSM with detectable viral load (VL) (>400 HIV-RNA copies/ml) decreased by 75% from 1,035 to 262. The incidence of syphilis and UAI rose dramatically in the same period, while CCRR decreased from 0.099 (CI95% 0.092-0.108) to 0.071 (CI 95% 0.065-0.079).
CONCLUSIONS: Our results strongly indicate that HAART has decreased the risk of transmission of HIV despite increased practise of unsafe sex and thereby substantiate that HAART should be offered to MSM to reduce risk of transmission of the disease.
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SEXUALLY HIV PREVENTION/PrEP/MICROBICIDE/ CIRCUMCISION RELATED ARTICLE SUMMARIES
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Sexuality and Disability Volume 30, Number 2 (2012), 199-208
Immigrant Workers’ Knowledge of HIV/AIDS and Their Sexual Risk Behaviors: A Respondent-Driven Sampling Survey in South Korea
Minsoo Jung
Abstract http://www.springerlink.com/content/n1356205684l47l2
As the labor market goes global, immigrant workers are becoming important around the world. However, little research has focused on the characteristics of their sex behaviors. This study examines foreign employees in Korea in order to investigate their understanding of HIV and sexual risk behaviors. The sample (N = 547) was formed from migrant workers in the industrial complex in Ansan district, which depends highly on foreigners as its labor source. Logistic regression, analysis revealed that 36.0% of the respondents were engaged in more than one sexual risk behavior. Those who knew someone infected with HIV (OR = 2.583) and Thai respondents (OR = 3.007) showed high sexual risk behaviors, while married (OR = 0.182) and Korean Chinese (OR = 0.280) workers showed low sexual risk behaviors. Those who had a wealth of knowledge about HIV took a less discriminatory position against the person who had infected them, but this had no statistical effects over the sexual risk behaviors.
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J Acquir Immune Defic Syndr. 2012 May 16. [Epub ahead of print]
Willingness of Kenyan HIV-1 serodiscordant couples to use antiretroviral based HIV-1 prevention strategies.
Heffron R, Ngure K, Mugo N, Celum C, Kurth A, Curran K, Baeten JM.
University of Washington, Seattle, WA; University of Nairobi, Nairobi, Kenya; Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; Kenyatta National Hospital, Nairobi, Kenya; New York University, New York, NY.
INTRODUCTION: Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) have demonstrated efficacy as new HIV-1 prevention approaches for HIV-1 serodiscordant couples.
METHODS: Among Kenyan HIV-1 serodiscordant heterosexual couples participating in a clinical trial of PrEP, we conducted a cross-sectional study and used descriptive statistical methods to explore couples’ willingness to use antiretrovirals for HIV-1 prevention. The study was conducted prior to July 2011, when studies among heterosexual populations reported that ART and PrEP reduced HIV-1 risk.
RESULTS: For 181 couples in which the HIV-1 infected partner had a CD4 count ≥350 cells/μL and had not yet initiated ART (and thus did not qualify for ART under Kenyan guidelines), 60.2% of HIV-1 infected partners (69.4% of men and 57.9% of women) were willing to use early ART (at CD4 ≥350 cells/μL) for HIV-1 prevention. Among HIV-1 uninfected partners, 92.7% (93.8% of men and 86.1% of women) reported willingness to use PrEP. When given a hypothetical choice of early ART or PrEP for HIV-1 prevention, 52.5% of HIV-1 infected participants would prefer to initiate ART early and 56.9% of HIV-1 uninfected participants would prefer to use PrEP.
CONCLUSIONS: Nearly 40% of Kenyan HIV-1 infected individuals in known HIV-1 serodiscordant partnerships reported reservations about early ART initiation for HIV-1 prevention. PrEP interest in this PrEP-experienced population was high. Strategies to achieve high uptake and sustained adherence to ART and PrEP for HIV-1 prevention in HIV-1 serodiscordant couples will require responding to couples’ preferences for prevention strategies.
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Health Place. 2012 Apr 26. [Epub ahead of print]
Are slum dwellers at heightened risk of HIV infection than other urban residents? Evidence from population-based HIV prevalence surveys in Kenya.
J Madise N, Ziraba AK, Inungu J, Khamadi SA, Ezeh A, Zulu EM, Kebaso J, Okoth V, Mwau M.
University of Southampton, Division of Social Statistics and Centre for Global Health, Population, Poverty, and Policy, University of Southampton, Southampton United Kingdom.
Abstract: http://www.sciencedirect.com/science/article/pii/S1353829212000652
In 2008, the global urban population surpassed the rural population and by 2050 more than 6 billion will be living in urban centres. A growing body of research has reported on poor health outcomes among the urban poor but not much is known about HIV prevalence among this group. A survey of nearly 3000 men and women was conducted in two Nairobi slums in Kenya between 2006 and 2007, where respondents were tested for HIV status. In addition, data from the 2008/2009 Kenya Demographic and Health Survey were used to compare HIV prevalence between slum residents and those living in other urban and rural areas. The results showed strong intra-urban differences. HIV was 12% among slum residents compared with 5% and 6% among non-slum urban and rural residents, respectively. Generally, men had lower HIV prevalence than women although in the slums the gap was narrower. Among women, sexual experience before the age of 15 compared with after 19 years was associated with 62% higher odds of being HIV positive. There was ethnic variation in patterns of HIV infection although the effect depended on the current place of residence.
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Ghana Med J. 2012 Mar;46(1):27-33.
Sexual Risk Behaviour Among HIV-Positive Persons in Kumasi, Ghana.
Ncube N, Akunna J, Babatunde F, Nyarko A, Yatich NJ, Ellis W, Turpin A, Jolly PE.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL,
Free PDF: http://www.ghanamedj.org/articles/March2012/Final%20Sexual%20risk%20behaviour.pdf
Abstract:
OBJECTIVES: To assess the prevalence and predictors of sexual risk behaviours among HIV-positive individuals in clinical care in Kumasi, Ghana.
DESIGN: Cross-sectional survey of 267 (43 males and 224 females) HIV-positive individuals attending Kumasi South Regional Hospital.
METHODS: An interviewer-administered questionnaire was used to asses demographic and health characteristics, HIV/AIDS knowledge, attitudes, and beliefs and sexual risk behaviours.
RESULTS: Forty-four percent of the sample reported having sex after testing positive for HIV. Of the 175 participants with regular sex partners, 24% had HIV-positive partners. Majority (67%) had HIV-negative partners (serodiscordant couples) or partners of unknown status. More than half (51%) of the study population with regular sex partners reported that they had unprotected anal or vaginal sex. Participants who scored < 50% on the HIV/AIDS knowledge scale were 90% less likely to have used condoms during their last sexual intercourse. Disclosure of HIV status was associated with protective patterns of condom use (OR=2.2; 95% CI: 1.3-12.9). Participants on ARV were 80% less likely to have used condoms during the last sexual intercourse (OR=0.2; 95% CI: 0.04-0.6).
CONCLUSION: The high rates of sexual risk behaviour among HIV-positive individuals in this sample place others at risk of HIV infection. It also places these HIV positive individuals at risk for infection with sexually transmitted infections and super-infection with other HIV strains. These findings highlight the need to integrate HIV prevention in routine medical care in Ghana.
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Trop Med Int Health. 2012 May 18. [Epub ahead of print]
The sexual behaviour of adolescents in sub-Saharan Africa: patterns and trends from national surveys.
Doyle AM, Mavedzenge SN, Plummer ML, Ross DA.
MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK Women’s Global Health Imperative, RTI International, San Francisco, CA; Social and Public Health Sciences Unit, Medical Research Council, Glasgow, UK.
Abstract: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2012.03005.x/abstract
Objectives: To describe the sexual and reproductive behaviour of adolescents in sub-Saharan Africa, particularly 15- to 19-year-olds.
Methods: Using DHS/AIS data (2000-2010), nine indicators of adolescent behaviour and one of adult attitudes towards condom education for adolescents were described for 24 countries. Indicators were disaggregated by gender, urban/rural residency and educational status, and time trends were described.
Results: Up to 25% of 15- to 19-year-olds reported sex before age 15; this proportion shrank over time in many countries. In most countries, ≥5% of females reported marriage before age 15, and >20% had commenced childbearing. Early sexual debut and childbearing were more common among the least educated and/or rural females. Reporting of multiple sexual partnerships was more common among males than among females, but decreases over time were more common among males. Urban males and females, and females with higher education, were more likely to report multiple partnerships. Urban youth and those with higher education also reported more condom use. Adult support for condom education for 12- to 14-year-olds has increased over time to 60-65%.
Conclusions: Many 15- to 19-year-olds are at risk of HIV/STIs and unplanned pregnancies because of multiple partnerships and insufficient condom and other contraceptive use. In many countries, trends are moving in a favourable direction. To better inform prevention programmes in this important area, we recommend routine collection of sexual and reproductive behaviour data for adolescents aged <15 years, expanding the data collected for 15- to 19-year-olds to include detailed information on sexual behaviour within partnerships, and disaggregating data according to sociodemographic variables.
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J Midwifery Womens Health. 2012 May;57(3):276-84.
What’s New in Sexually Transmitted Infection Management: Changes in the 2010 Guidelines from the Centers for Disease Control and Prevention.
Mark H, Jordan ET, Cruz J, Warren N.
Abstract: http://onlinelibrary.wiley.com/doi/10.1111/j.1542-2011.2012.00179.x/abstract
Screening, treatment, and follow-up of sexually transmitted infections (STIs) are an important part of the role of women’s health care providers. Keeping abreast of new and changing treatment guidelines is crucial to providing competent care. The Sexually Transmitted Diseases Treatment Guidelines, produced every 4 years by the Centers for Disease Control and Prevention, summarize current evidence on prevention, diagnosis, and treatment of STIs. The purpose of this article is to review the changes in the 2010 guidelines from the previous 2006 guidelines. These changes include new diagnostic tests for bacterial vaginosis, Neisseria gonorrhoeae, and human papillomavirus; new treatment recommendations for bacterial vaginosis, gonorrhea, and genital warts; the increasing prevalence of antimicrobial-resistant N gonorrhoeae; new criteria for spinal fluid examination to evaluate for neurosyphilis; and the emergence of azithromycin-resistant Treponema pallidum.
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Human Trafficking Is More Than Sex Trafficking and Prostitution: Implications for Social Work
Maria Beatriz Alvarez and Edward J. Alessi
Affilia 2012;27 142-152
http://aff.sagepub.com/cgi/content/abstract/27/2/142?etoc
Abstract
The human trafficking discussion has focused primarily on women and children who are trafficked for sexual exploitation. However, as social workers confront the issue, they require an understanding of the problem that also acknowledges individuals who are forced to work in other areas. This article critically examines the current discourse on human trafficking because the sole focus on women and children diverts attention from the study of trafficking within the context of globalization and the exploitation of labor. It analyzes the term human trafficking, particularly how it became linked to antiprostitution campaigns, and suggests guidelines for a framework that is grounded in social work values.
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HIV Testing, Diagnosis, Epidemological Issues (e.g. prevalence, incidence, mortality) Article Summaries
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Acad Emerg Med. 2012 May;19(5):604-7.
Racial disparities in testing for sexually transmitted infections in the emergency department.
Goyal MK, Hayes KL, Mollen CJ.
From the Children’s Hospital of Philadelphia (MKG, KLH, CJM), University of Pennsylvania School of Medicine (MKG, CJM), Leonard Davis Institute of Health Economics (MKG), University of Pennsylvania, Philadelphia, PA.
Abstract: http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2012.01338.x/abstract
Objectives: The objective of this study was to determine predictors of sexually transmitted infection (STI) testing among adolescent females presenting to an urban pediatric emergency department (ED) with symptoms potentially suggestive of an STI. Methods: This was a secondary analysis of data collected in a prospective prevalence study of STIs among a consecutive sample of symptomatic females aged 14 to 19 years presenting to a pediatric ED with lower abdominal or genitourinary complaints. The outcome of interest was performance of an STI test. Correlates of interest included patient age, race, insurance status, chief complaint, presence of comorbid conditions, and treating physician sex.
Results: Of the 328 adolescent females who presented to the ED with STI-related complaints and met inclusion criteria, 15.6% did not undergo STI testing. Univariable analysis revealed that black or African American race (odds ratio [OR]=4.98, 95% confidence interval [CI]=2.67 to 9.30) and nonprivate insurance (OR=3.47; 95% CI=1.83 to 6.58) were significantly associated with the performance of STI testing. In a multivariable model, only black or African American race (OR=3.94; 95% CI=1.96 to 7.91) remained significantly associated with the performance of STI testing.
Conclusions: A substantial number of adolescent females who presented with complaints suggestive of an STI did not undergo STI testing, and a racial disparity in STI testing was noted. The racial disparity in rates of STI testing among symptomatic adolescent girls presenting to the ED warrants further study to confirm validity, to determine if disparity reflects physicians’ biases, and to inform strategies for controlling the present epidemic of STIs in adolescents.
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Trop Med Int Health. 2012 May 16. [Epub ahead of print]
Mortality of HIV-infected and uninfected children in a longitudinal cohort in rural south-west Uganda during 8 years of follow-up.
Munyagwa M, Baisley K, Levin J, Brian M, Grosskurth H, Maher D.
MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda London School of Hygiene and Tropical Medicine, London, UK East and North Hertfordshire NHS Trust, Stevenage, UK.
Abstract: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2012.03000.x/abstract
Objectives: To determine the impact of HIV on child mortality and explore potential risk factors for mortality among HIV-infected and HIV-exposed uninfected children in a longitudinal cohort in rural Uganda.
Methods: From July 2002 to March 2010, HIV-infected and HIV-exposed uninfected children aged 6 weeks-13 years were enrolled in an open population-based clinical cohort. Antiretroviral therapy (ART) was introduced in 2005. Clinical and laboratory data were collected every 3 months. Person-years at risk were calculated from time of enrolment until earliest date of ART initiation, death or last visit. Cox regression was used to estimate hazard ratios (HR) for mortality.
Results: Eighty-nine (30.2%) HIV-infected and 206 (69.8%) HIV-exposed but uninfected children were enrolled. Twenty-one children died. The mortality rate was six times higher in ART-naive HIV-infected children than in HIV-exposed but uninfected children (HR=6.4, 95% CI=2.4-16.6). Among HIV-infected children, mortality was highest in those aged <2 years. Decreasing weight-for-age Z (WAZ) score was the strongest risk factor for mortality among HIV-infected children (HR for unit decrease in WAZ=2.6, 95% CI=1.6-4.1). Thirty-five children (aged 7 months-15.6 years; median, 5.4 years) started ART.
Conclusions: Mortality among HIV-infected children was highest among those aged <2 years. Intensified efforts to prevent mother-to-child transmission of HIV and ensure early HIV diagnosis and treatment are required to decrease child mortality caused by HIV in rural Africa.
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Quantifying the Benefits of Link-Tracing Designs for Partnership Network Studies
Jimi Adams, James Moody, Stephen Q. Muth, and Martina Morris
Field Methods 2012;24 175-193
http://fmx.sagepub.com/cgi/content/abstract/24/2/175?etoc
Abstract
Difficult-to-reach populations are frequently sampled through various link tracing-based designs, which rely on interpersonal networks to identify members of the population. This article examines the substantive returns to one such multiple-link tracing design in the Colorado Springs “project 90” human immunodeficiency virus (HIV) risk networks study. Cross-links were respondents who were targeted for enrollment because of being named as partners by at least two other respondents in the sample. The authors compare cross-links to other respondents on sociodemographic characteristics and network properties using bivariate and multivariate adjusted statistics. The authors evaluate their contributions to observed network structure by creating a set of counterfactual networks deleting the information they provided. Results suggest that the link-tracing techniques led to identifying populations that would have otherwise been missed and that their absence would have underestimated potential HIV risk by distorting epidemiologically relevant measures within the network
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Asia Pac J Public Health. 2012 May 16. [Epub ahead of print]
Trends and Barriers to HIV Testing Among Tuberculosis Patients in Prey Kabas Operational District, Takeo Province, Cambodia.
Samrith W, Rahman M, Harun-Or-Rashid M, Sakamoto J.
Nagoya University Graduate School of Medicine, Nagoya, Japan; Ministry of Health, Takhmao Town, Cambodia.
Abstract: http://aph.sagepub.com/content/early/2012/05/03/1010539512445190.abstract
Data for this study were obtained from 2375 tuberculosis (TB) patients registered during 2007-2009 and 43 health providers to examine the trend of TB patient referral for HIV (human immunodeficiency virus) testing and to investigate provider-associated barriers to the referral in Prey Kabas operational district, Takeo province, Cambodia. Referral rate for HIV testing was 4.4% (30/684) in 2007, 15.4% (116/751) in 2008, and 30.1% (283/940) in 2009, with a significant upward trend over the period of time (P = .009). The main barriers perceived by health providers were poor knowledge about TB/HIV, lack of communication skills, absence of any target plan for TB patient referral for HIV testing, and fear associated with informing positive test results to the TB patients and the associated stigma. Strategies to raise awareness about HIV/AIDS/TB among TB patients and their providers may improve the current state of low referral and its barriers in Cambodia.
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Lab Chip. 2012 May 17. [Epub ahead of print]
Integrated rapid-diagnostic-test reader platform on a cellphone.
Mudanyali O, Dimitrov S, Sikora U, Padmanabhan S, Navruz I, Ozcan A.
Electrical Engineering Department, University of California, Los Angeles, CA. ozcan@ucla.edu.
Abstract: http://pubs.rsc.org/en/Content/ArticleLanding/2012/LC/c2lc40235a
We demonstrate a cellphone-based rapid-diagnostic-test (RDT) reader platform that can work with various lateral flow immuno-chromatographic assays and similar tests to sense the presence of a target analyte in a sample. This compact and cost-effective digital RDT reader, weighing only ∼65 g, mechanically attaches to the existing camera unit of a cellphone, where various types of RDTs can be inserted to be imaged in reflection or transmission modes under light-emitting diode (LED)-based illumination. Captured raw images of these tests are then digitally processed (within less than 0.2 s per image) through a smart application running on the cellphone for validation of the RDT, as well as for automated reading of its diagnostic result. The same smart application then transmits the resulting data, together with the RDT images and other related information (e.g., demographic data), to a central server, which presents the diagnostic results on a world map through geo-tagging. This dynamic spatio-temporal map of various RDT results can then be viewed and shared using internet browsers or through the same cellphone application. We tested this platform using malaria, tuberculosis (TB) and HIV RDTs by installing it on both Android-based smartphones and an iPhone. Providing real-time spatio-temporal statistics for the prevalence of various infectious diseases, this smart RDT reader platform running on cellphones might assist healthcare professionals and policymakers to track emerging epidemics worldwide and help epidemic preparedness.
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Am J Public Health. 2012 May 17. [Epub ahead of print]
Racial Residential Segregation and Rates of Gonorrhea in the United States, 2003-2007.
Biello KB, Kershaw T, Nelson R, Hogben M, Ickovics J, Niccolai L.
Yale School of Public Health and Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
Objectives. In the United States, Black persons are disproportionately affected by sexually transmitted infections (STIs), including gonorrhea. Individual behaviors do not fully explain these racial disparities. We explored the association of racial residential segregation with gonorrhea rates among Black persons and hypothesized that specific dimensions of segregation would be associated with gonorrhea rates.
Methods. We used 2003 to 2007 national STI surveillance data and 2000 US Census Bureau data to examine associations of 5 dimensions of racial residential segregation and a composite measure of hypersegregation with gonorrhea rates among Black persons in 257 metropolitan statistical areas, overall and by sex and age. We calculated adjusted rate ratios with generalized estimating equations.
Results. Isolation and unevenness were significantly associated with gonorrhea rates. Centralization was marginally associated with gonorrhea. Isolation was more strongly associated with gonorrhea among the younger age groups. Concentration, clustering, and hypersegregation were not associated with gonorrhea.
Conclusions. Certain dimensions of segregation are important in understanding STI risk among US Black persons. Interventions to reduce sexual risk may need to account for racial residential segregation to maximize effectiveness and reduce existent racial disparities.
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Ann Surg. 2012 May 10. [Epub ahead of print]
Factors Predictive of 30-Day Postoperative Mortality in HIV/AIDS Patients in the Era of Highly Active Antiretroviral Therapy.
Wiseman SM, Forrest JI, Chan JE, Zhang W, Yip B, Hogg RS, Lima VD, Montaner JS.
University of British Columbia, Vancouver; British Columbia Centre for Excellence in HIV/AIDS, Vancouver; Simon Fraser University, Burnaby
BACKGROUND: Factors that predict HIV (human immunodeficiency virus)/AIDS patient postoperative mortality have remained poorly defined.
OBJECTIVES: The primary objective of this study was to identify factors predictive of short-term, postoperative mortality in HIV/AIDS patients. The secondary objective of this study was to develop a scoring system that would predict short-term postoperative mortality in HIV/AIDS patients.
METHODS: We retrospectively reviewed all HIV/AIDS patients who underwent surgical procedures in British Columbia, Canada, between April 1995 and March 2002. The primary outcome evaluated was 30-day postoperative mortality. Demographic, clinical, and hospitalization-related data were obtained and utilized to predict outcomes using a logistic regression model.
RESULTS: A total of 2305 procedures were carried out on 1322 patients during the study period. Admissions were classified as urgent/emergent for 1311 procedures (57%) and the overall 30-day postoperative mortality was 9.5% (126 deaths). Urgent/emergent admission, older age, prior surgery, a CD4 cell count of ≤ 50 cells/mm, a hemoglobin level ≤ 120 g/L, and a white blood cell count >11 g/L within 90 days before the surgical procedure was predictive of an increased 30-day postoperative mortality in a multivariate model. Using these variables, we formulated the HIV Surgical Mortality Score (HSMS) to obtain the median-estimated probability of postoperative death.
CONCLUSIONS: For accurate preoperative mortality risk stratification for HIV/AIDS patients, we have found that several clinical and laboratory variables must be evaluated. If appropriately validated, our proposed HSMS could be utilized to estimate the probability of short-term postoperative death among HIV/AIDS patients.
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Lab Chip. 2012 May 17. [Epub ahead of print]
Integrated rapid-diagnostic-test reader platform on a cellphone.
Mudanyali O, Dimitrov S, Sikora U, Padmanabhan S, Navruz I, Ozcan A.
Source
Electrical Engineering Department, University of California, Los Angeles, CA 90095, USA. ozcan@ucla.edu
Abstract http://pubs.rsc.org/en/Content/ArticleLanding/2012/LC/c2lc40235a
We demonstrate a cellphone-based rapid-diagnostic-test (RDT) reader platform that can work with various lateral flow immuno-chromatographic assays and similar tests to sense the presence of a target analyte in a sample. This compact and cost-effective digital RDT reader, weighing only ∼65 g, mechanically attaches to the existing camera unit of a cellphone, where various types of RDTs can be inserted to be imaged in reflection or transmission modes under light-emitting diode (LED)-based illumination. Captured raw images of these tests are then digitally processed (within less than 0.2 s per image) through a smart application running on the cellphone for validation of the RDT, as well as for automated reading of its diagnostic result. The same smart application then transmits the resulting data, together with the RDT images and other related information (e.g., demographic data), to a central server, which presents the diagnostic results on a world map through geo-tagging. This dynamic spatio-temporal map of various RDT results can then be viewed and shared using internet browsers or through the same cellphone application. We tested this platform using malaria, tuberculosis (TB) and HIV RDTs by installing it on both Android-based smartphones and an iPhone. Providing real-time spatio-temporal statistics for the prevalence of various infectious diseases, this smart RDT reader platform running on cellphones might assist healthcare professionals and policymakers to track emerging epidemics worldwide and help epidemic preparedness.
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Women/Maternal/Child/Perinatal transmission RELATED ARTICLE SUMMARIES
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Bull World Health Organ. 2012 May 1;90(5):348-56.
Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results.
Seidenberg P, Nicholson S, Schaefer M, Semrau K, Bweupe M, Masese N, Bonawitz R, Chitembo L, Goggin C, Thea DM.
Not yet available on Journal site
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/22589568.1
OBJECTIVE: To see if, in the diagnosis of infant infection with human immunodeficiency virus (HIV) in Zambia, turnaround times could be reduced by using an automated notification system based on mobile phone texting.
METHODS: In Zambia’s Southern province, dried samples of blood from infants are sent to regional laboratories to be tested for HIV with polymerase chain reaction (PCR). Turnaround times for the postal notification of the results of such tests to 10 health facilities over 19 months were evaluated by retrospective data collection. These baseline data were used to determine how turnaround times were affected by customized software built to deliver the test results automatically and directly from the processing laboratory to the health facility of sample origin via short message service (SMS) texts. SMS system data were collected over a 7.5-month period for all infant dried blood samples used for HIV testing in the 10 study facilities.
FINDINGS: Mean turnaround time for result notification to a health facility fell from 44.2 days pre-implementation to 26.7 days post-implementation. The reduction in turnaround time was statistically significant in nine (90%) facilities. The mean time to notification of a caregiver also fell significantly, from 66.8 days pre-implementation to 35.0 days post-implementation. Only 0.5% of the texted reports investigated differed from the corresponding paper reports.
CONCLUSION: The texting of the results of infant HIV tests significantly shortened the times between sample collection and results notification to the relevant health facilities and caregivers.
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Glob Public Health. 2012 May 17. [Epub ahead of print]
HIV+ women’s narratives of non-disclosure: Resisting the label of immorality.
Groves AK, Maman S, Moodley D.
Health Behavior and Health Education, UNC Gillings School of Global Public Health, Chapel Hill, NC.
Increasing partner disclosure rates among HIV+ individuals is widely seen as an important public health strategy to reduce HIV transmission. One approach for encouraging disclosure is to emphasise individuals’ moral responsibility to disclose their status to their partners. We use South Africa as a case study to draw attention to two problems with labelling non-disclosure as immoral. First, we argue that because women are tested for HIV at much higher rates than men, any approach that involves blaming HIV+ individuals for not disclosing their status will disproportionately burden women. Second, through the narratives of six HIV+ women, we highlight how a focus on morality undervalues the complexity of sexual partnerships. Specifically, women describe how their perceived obligation to disclose their status is directly influenced by communication with their sexual partners. Women also discuss how the onset of different life events might alter the meaning of HIV and change obligations regarding disclosure within the partnership. The differences in testing rates across gender combined with the complexity of sexual partnerships leads us to suggest that labelling non-disclosure as immoral does little to advance HIV prevention. There is an urgent need to identify alternative interventions that support women through the disclosure process.
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J Pregnancy. 2012;2012:140826. Epub 2012 Apr 22.
HIV/AIDS, Tuberculosis, and Malaria in Pregnancy.
Ezechi O, Odberg Petterson K, Byamugisha J.
Maternal and Reproductive Health Research Unit, Division of Clinical Sciences, Nigerian Institute of Medical Research, Yaba Lagos, Nigeria.
Free HTML: http://www.hindawi.com/journals/jp/2012/140826/
Free PDF: http://downloads.hindawi.com/journals/jp/2012/140826.pdf
Editorial/Excerpt…
HIV/AIDS, tuberculosis (TB), and malaria (ATM) are 3 major global public health threats that undermine development in low- and middle-income countries [1].
Approximately 5 million lives are lost annually as a result of these infections, with substantial humanitarian, economic, and social impact, which is still not fully measured [1]. The three infections are not only associated with poverty but also occur in the same geographic zone and have major public health implications [2]. The consequences of interactions between the diseases are particularly serious for reproductive health. They often intersect in pregnancy, resulting in poor maternal and fetal outcomes. As access to their treatment is increasing in low-income countries and new and cheaper alternative drugs are being deployed, there is also the potential for interactions between their treatments, which affects the efficacy of each drug…
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J Acquir Immune Defic Syndr. 2012 May 15. [Epub ahead of print]
Provision of Services and Care for HIV-Exposed Infants: A comparison of Maternal and Child Health (MCH) Clinic and HIV Comprehensive Care Clinic (CCC) models.
Ongʼech JO, Hoffman HJ, Kose J, Audo M, Matu L, Savosnick P, Guay L.
Kenyatta National Hospital, Nairobi, Nairobi KENYA The George Washington University School of Public Health and Health Services, Washington, DC, USA Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC.
OBJECTIVE: Prevention of Mother-to-Child transmission of HIV programs require follow-up of HIV exposed infants (HEI) for infant feeding support, prophylactic medicines, and HIV diagnosis for at least 18 months. Retention in care and receipt of HIV services are challenging in resource limited settings. This study compared infant follow-up results when HEI services were provided within Maternal and Child Health (MCH) clinics or in specialized HIV Comprehensive Care Clinics (CCC) in Kenya.
METHODS: This observational prospective cohort study enrolled HIV exposed infants at 6-8 weeks of age in two purposively selected hospitals with similar characteristics but different models of service delivery. In the CCC model, HEI received immunization and growth monitoring in MCH but cotrimoxazole prophylaxis and infant HIV testing in the CCC. In the MCH model, all services were provided in the MCH. Data was collected at enrollment, 14 weeks, 6, 9, and 12 months.
RESULTS: From April 2008-April 2009, 184 HEI were enrolled in the CCC cohort and 179 in the MCH cohort. Infants in MCH were 1.14, 1.42,1.95, and 1.29 times more likely to attend 14-week, 6, 9, and 12-month postnatal visits, respectively, and 2.24 (95% CI: 1.57,3.18) times more likely to attend all four visits. While infants in MCH were 1.33 (95% CI ;1.10,1.62) times more likely to have HIV antibody testing at 1 year than CCC, there were no differences for PCR test or cotrimoxazole initiation at 6-8 weeks.
CONCLUSION: HIV services integrated in MCH yield better follow-up of HIV-exposed infants than CCC.
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J Acquir Immune Defic Syndr. 2012 May 15. [Epub ahead of print]
Antiretroviral Treatment Interruptions Predict Female Genital Shedding of Genotypically Resistant HIV-1 RNA.
Graham SM, Jalalian-Lechak Z, Shafi J, Chohan V, Deya RW, Jaoko W, Mandaliya KN, Peshu NM, Overbaugh J, McClelland RS.
University of Washington, Seattle, Washington; University of Nairobi, Nairobi, Kenya; Kenya Medical Research Institute, Kilifi, Kenya; Fred Hutchinson Cancer Research Center, Seattle, Washington; PathCare, Mombasa, Kenya.
OBJECTIVES: Resistant viruses may emerge in the female genital tract during antiretroviral therapy (ART). Our objective was to identify predictors of drug-resistant HIV-1 RNA in genital secretions after initiation of non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy.
DESIGN: We conducted a prospective cohort study with periodic evaluation of plasma and genital swab samples for HIV-1 RNA levels and antiretroviral resistance mutations.
METHODS: First-line ART was initiated in 102 women. Plasma and genital HIV-1 RNA levels were measured at months 0, 3, 6, and 12. Genotypic resistance testing was performed for samples from all participants with RNA >1,000 copies/mL at month 6 or 12. Cox regression analysis was used to identify factors associated with incident genital tract resistance.
RESULTS: Detectable genital tract resistance developed in 5 women, all with detectable plasma resistance (estimated incidence, 5.5/100 person-years of observation). Treatment interruption >48 hours, adherence by pill count, adherence by visual analog scale, and baseline plasma viral load were associated with incident genital tract resistance. In multivariate analysis, only treatment interruption was associated with risk of detectable genital tract resistance (adjusted hazard ratio 14.2, 95% CI 1.3-158.4).
CONCLUSIONS: Treatment interruption >48 hours during NNRTI-based therapy led to a significantly increased risk of detecting genotypically resistant HIV-1 RNA in female genital tract secretions. Patient- and program-level interventions to prevent treatment interruptions could reduce the risk of shedding resistant HIV-1 during ART.
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Pediatr Infect Dis J. 2012 May 15. [Epub ahead of print]
HIV and Hepatitis B Co-infection among Perinatally HIV-infected Thai Adolescents.
Aurpibul L, Lumbiganon P, Kolasaraksa P, Hansudewechakul R, Sa-Nguanmoo P, Taeprasert P, Bunupuradah T, Pooworawan Y, Sirisanthana V, Puthanakit T.
Research Institute for Health Sciences, Chiang Mai University, Chiang Mai; Srinagarind Hospital, Khon Kaen University, Khon Kaen; Chiangrai Prachanukroh Hospital, Chiangrai…
OBJECTIVE: This study aimed to determine the prevalence of hepatitis B virus (HBV) co-infection and HBV seropositivity in perinatally HIV-infected adolescents. A secondary objective was to describe the clinical characteristics of adolescents with chronic HBV/HIV co-infection.
DESIGN: Multi-center cross-sectional study of perinatally HIV-infected adolescents aged 12-25 years.
METHODS: HBV surface antigen (HBsAg), surface antibody (anti-HBs) and core antibody (anti-HBc) were measured. Co-infection was defined as having persistently positive HBsAg. Seroprotective antibody from immunization was defined as having anti-HBs ≥ 10 mIU/mL with negative anti-HBc.HBV DNA quantitation and rtM204V/I mutation analysis (lamivudine resistance-associated mutation) were performed in adolescents with chronic HBV infection
RESULTS: From November 2010 to March 2011, 521 patients were enrolled. Mean (standard deviation) of CD4 lymphocyte count was 685(324) cells/ µl. Prevalence of HBV/HIV co-infected was 3.3%; 95% CI: 1.9% to 5.2 %. Protective antibody against HBV was found in 18% of population, and this was significantly higher among adolescents who received vs. those who did not receive HBV revaccination after receiving antiretroviral therapy (ART) (93% vs. 6%, p<0.01). Among adolescents with chronic HBV infection, 88% have received lamivudine; however 69% have HBV DNA > 10 copies/ml, and 75% had the rtM204V/I mutation.
CONCLUSIONS: The prevalence of HBV co-infection in HIV-infected Thai adolescents was 3.3%. Most HIV-infected adolescents had no HBV protective antibody; therefore revaccination with HBV vaccine is encouraged. The high prevalence of HBV-lamivudine resistance underscores the importance of HBV screening prior to ART initiation to guide selection of the optimal regimen for co-infected children.
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Menopause. 2012 Apr 30. [Epub ahead of print]
Age at menopause and menopause-related symptoms in human immunodeficiency virus-infected Thai women.
Boonyanurak P, Bunupuradah T, Wilawan K, Lueanyod A, Thongpaeng P, Chatvong D, Sophonphan J, Saeloo S, Ananworanich J, Chaithongwongwatthana S.
Phramongkutklao Hospital of the Royal Thai Army, Bangkok, Thailand; Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Chulalongkorn University, Bangkok, Thailand.
OBJECTIVE: There are limited data for age at menopause (AM) and menopause-related symptoms in human immunodeficiency virus (HIV)-infected Asian women. We investigated AM and menopause-related symptoms in HIV-infected Thai women.
METHODS: HIV-infected Thai women 40 years or older who did not receive any hormone therapy in the 8-week period preceding the study were enrolled. Participants completed the Menopause-Specific Quality of Life survey for their symptoms in the past 30 days. Menopause was defined as having the last menstrual period more than 1 year ago. Multivariate Cox proportional hazard regression analysis was used to identify factors associated with menopause.
RESULTS: Two hundred sixty-eight HIV-infected women were enrolled; their median age was 44.6 (41.8-48.7) years, and the ratio of their Centers for Disease Control and Prevention clinical classifications (A:B:C) was 53%:34%:13%; 95% were using highly active antiretroviral therapy. The median (interquartile range [IQR]) CD4 count was 575 (437-758) cells/μL, and 93% had HIV-RNA of less than 1.7log10 copies/mL. Among the 55 women who had reached menopause, the mean (SD) AM was 47.3 (5.1) years. The mean (SD) AM in our study was earlier than the previous report of 49.5 (3.6) years in non-HIV-infected Thai women (difference, -2.2 y; 95% CI, -3.2 to -1.2, P < 0.01). Postmenopausal women had more symptoms, including night sweats (P = 0.03), change in sexual desire (P = 0.01), and avoiding intimacy (P = 0.01), compared with nonpostmenopausal women. No differences in psychosocial or physical domains between groups were found. Factors associated with menopause were Centers for Disease Control and Prevention clinical classification B or C (hazard ratio, 1.7; 95% CI, 1.0-3.03, P = 0.04), and no sexual act in the past month (hazard ratio, 4.9; 95% CI, 1.5-16.0, P = 0.01). No associations of later age of menarche, parity, marital status, educational level, income, body mass index, CD4 count, and HIV-RNA with menopause were found.
CONCLUSIONS: AM in HIV-infected Thai women was 47.3 years, which is significantly earlier than the findings of a previous AM report on non-HIV-infected women. Postmenopausal HIV-infected women had more vasomotor and sexual symptoms. More studies are needed to investigate the cause and appropriate interventions for accelerated menopause in HIV-infected women.
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Health Psychol. 2012 Apr 30. [Epub ahead of print]
Cognitive-Behavioral Stress Management and Psychological Well-Being in HIV+ Racial/Ethnic Minority Women With Human Papillomavirus.
Jensen SE, Pereira DB, Whitehead N, Buscher I, McCalla J, Andrasik M, Rose R, Antoni MH.
Abstract: http://psycnet.apa.org/psycinfo/2012-10746-001/
Objective: This study is a secondary analysis examining the effects of a cognitive-behavioral stress management (CBSM) intervention on indicators of positive psychological well-being and negative psychological well-being in HIV-positive racial/ethnic minority women at risk for cervical cancer due to human papillomavirus (HPV) infection and/or cervical intraepithelial lesions (CIN).
Method: Racial/ethnic minority women with HIV and HPV and/or CIN I were randomized to a 10-week CBSM group or a 1-day psychoeducational seminar. Participants completed a battery of measures of positive and negative psychological well-being at 3 time points: preintervention, 3 months postenrollment, and 9 months postenrollment.
Results: Women in the CBSM group reported significant increases in domains of positive well-being, with no changes among women in the psychoeducational seminar, F(6, 63) = 2.42, p < .05, η2 = .19. There were no significant changes in domains of negative well-being across time for either group, F(2, 65) = 2.60, p = .08, η2 = .07.
Conclusion: These findings suggest that racial/ethnic minority women with HIV at risk for cervical cancer who were randomized to a 10-week CBSM group experienced enhanced positive well-being. The lack of effects on negative well-being may be due to the relatively low levels of negative well-being present in this sample at study entry. Future research should examine whether these effects are replicated in a randomized controlled trial of women with biopsy-confirmed CIN who present with greater distress levels that also employs a time-equivalent comparison condition. (PsycINFO Database
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Clinical/Treatment: ARV/BIOMEDICAL HIV+ CARE/CORMOBIDITIES, TECHNOLOGY RELATED ARTICLE SUMMARIES
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Acad Emerg Med. 2012 May;19(5):497-503.
Factors Associated With No or Delayed Linkage to Care in Newly Diagnosed Human Immunodeficiency Virus (HIV)-1-Infected Patients Identified by Emergency Department-based Rapid HIV Screening Programs in Two Urban EDs.
Rothman RE, Kelen GD, Harvey L, Shahan JB, Hairston H, Burah A, Moring-Parris D, Hsieh YH.
From the Department of Emergency Medicine (RER, GDK, LH, JBS, HH, AB, DMP, YHH) and the Division of Infectious Diseases (RER), The Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract: http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2012.01351.x/abstract
Objectives: The objective was to describe the proportions of successful linkage to care (LTC) and identify factors associated with LTC among newly diagnosed human immunodeficiency virus (HIV)-positive patients, from two urban emergency department (ED) rapid HIV screening programs.
Methods: This was a retrospective analysis of programmatic data from two established urban ED rapid HIV screening programs between November 2005 and October 2009. Trained HIV program assistants interviewed all patients tested to gather risk behavior data using a structured data collection instrument. Reactive results were confirmed by Western blot testing. Patients were provided with scheduled appointments at HIV specialty clinics at the institutions where they tested positive within 30 days of their ED visit. “Successful” LTC was defined as attendance at the HIV outpatient clinic within 30 days after HIV diagnosis, in accordance with the ED National HIV Testing Consortium metric. “Any” LTC was defined as attendance at the outpatient HIV clinic within 1 year of initial HIV diagnosis. Multivariate logistic regression was performed to determine factors associated with any LTC or successful LTC.
Results: Of the 15,640 tests administered, 108 (0.7%) were newly identified HIV-positive cases. Nearly half (47.2%) of the patients had been previously tested for HIV. Successful LTC occurred in 54% of cases; any LTC occurred in 83% of cases. In multivariate analysis, having public medical insurance and being self-pay were negatively associated with successful LTC (odds ratio [OR]=0.33, 95% confidence interval [CI]=0.12 to 0.96; OR=0.34, 95% CI=0.13 to 0.89, respectively); being female and having previously tested for HIV was negatively associated with any LTC (OR=0.30, 95% CI=0.10 to 0.93; OR=0.23, 95% CI=0.07 to 0.77, respectively).
Conclusions: In spite of dedicated resources for arranging LTC in the ED HIV testing programs, nearly 50% of patients did not have successful LTC (i.e., LTC occurred at >30 days), although >80% of patients were LTC within 1 year of initial diagnosis. Further evaluation of the barriers associated with successful LTC for those with public insurance and self-pay is warranted.
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Rev Epidemiol Sante Publique. 2012 May 15. [Epub ahead of print]
[Self-disclosure of a HIV-positive serostatus: Factors favoring disclosure and consequences for persons living with HIV/AIDS in Burkina Faso.]
[Article in French]
Kouanda S, Yaméogo WM, Berthé A, Bila B, Bocoum Yaya FK, Somda A, Doulougou B, Sanou MJ, Sondo B, Msellati P.
Institut de recherche en sciences de la santé (IRSS), 03 BP 7192, Ouagadougou, Burkina Faso.
Abstract: http://www.em-consulte.com/article/713481/alertePM
Disclosure of HIV-serostatus remains a way to avoid sexual transmission of HIV because it allows partners to take the necessary protective measures, e.g. use of condoms. Disclosure is nevertheless difficult due to the discrimination associated with HIV. The objective of this study was to analyze factors leading to self-disclosure of HIV-positive status within a sample of persons of both sexes attending different healthcare services in Burkina Faso.
METHODOLOGY: Cross-sectional study conducted by interviewing 740 patients in 26 healthcare services. Univariate (Chi(2) test) and multivariate (logistic regression) analyses were performed. The significance level was 5%. Qualitative data on factors associated with self-disclosure of HIV-positive status were analyzed.
RESULTS: The majority of the patients (81.4%) informed at least one person who was very often a close relative (descendant, ascendant and sibling) or the partner. At multivariate analysis, HIV-serostatus was associated with using antiretroviral treatment, (OR=0.40, 95% CI: 0.3-0.7, P<0.001), known HIV-serostatus for at least one year (OR=0.6; 95% CI: 0.4-0.9), living in couple (2.3; 95% CI: 1.4-3.8).
CONCLUSION: In a context limiting HIV testing due to the fear of social stigma, these results appear to be in favor of the Voluntary Counseling Testing model with a focus on the couple and/or families.
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PLoS One. 2012;7(5):e36792. Epub 2012 May 11.
Patient Enrolment into HIV Care and Treatment within 90 Days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-Based Registers.
Kayigamba FR, Bakker MI, Fikse H, Mugisha V, Asiimwe A, Schim van der Loeff MF.
INTERACT, Kigali, Rwanda.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0036792
Abstract:
INTRODUCTION: Access to antiretroviral therapy (ART) has increased greatly in sub-Saharan Africa. However many patients do not enrol timely into HIV care and treatment after HIV diagnosis. We studied enrolment into care and treatment and determinants of non-enrolment in Rwanda.
METHODS: Data were obtained from routine clinic registers from eight health facilities in Rwanda on patients who were diagnosed with HIV at the antenatal care, voluntary counselling-and-testing, outpatient or tuberculosis departments between March and May 2009. The proportion of patients enrolled into HIV care and treatment was calculated as the number of HIV infected patients registered in ART clinics for follow-up care and treatment within 90 days of HIV diagnosis divided by the total number of persons diagnosed with HIV in the study period.
RESULTS: Out of 482 patients diagnosed with HIV in the study period, 339 (70%) were females, and the median age was 29 years (interquartile range [IQR] 24-37). 201 (42%) enrolled into care and treatment within 90 days of HIV diagnosis. The median time between testing and enrolment was six days (IQR 2-14). Enrolment in care and treatment was not significantly associated with age, sex, or department of testing, but was associated with study site. None of those enrolled were in WHO stage 4. The median CD4 cell count among adult patients was 387 cells/mm(3) (IQR: 242-533 cells/mm(3)); 81 of 170 adult patients (48%) were eligible to start ART (CD4 count<350 cells/mm(3) or WHO stage 4). Among those eligible, 45 (56%) started treatment within 90 days of HIV diagnosis.
CONCLUSION: Less than 50% of diagnosed HIV patients from eight Rwandan health facilities had enrolled into care and treatment within 90 days of diagnosis. Improving linkage to care and treatment after HIV diagnosis is needed to harness the full potential of ART.
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Consult Pharm. 2012 May;27(5):358-64.
HIV: A Growing Concern in the Elderly Population.
Vouri SM, Blaszczyk AT.
St. Louis College of Pharmacy, St. Louis, Missouri.
Abstract: http://ascp.metapress.com/content/q7x4528q2x5x1t73/
HIV infections are a growing concern in the elderly as a result of improvements in therapeutics and monitoring, which have extended the life span for this HIV-infected population. Elderly patients potentially are more complicated to treat than younger HIV-infected individuals because of comorbidities and the physiological effects of aging on pharmacokinetics and pharmacodynamics. The patient, a 67-year-old African-American HIV-infected male, presents to the transitional care unit of university-affiliated hospital refusing to take medications and undergo laboratory testing, including blood draws. This patient’s treatment is further complicated by poor renal function, medications with potential interactions, and a recent diagnosis of depression. This case demonstrates treatment and monitoring of an elderly patient with HIV and reveals the complications associated with this disease state. Specifically, it identifies nonadherence to medications and a lack of laboratory results, which affect the efficacy of treatment and monitoring, medication adjustments based on metabolism and renal excretion, monitoring of adverse effects of HIV and antiretro-viral therapy, and comorbid conditions that may be linked to HIV and antiretroviral therapy such as depression and bone disease. Education on HIV medications, monitoring, and standards of care for pharmacists working with the geriatric population is warranted and should be emphasized as the HIV-infected elderly population continues to grow.
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Pediatr Infect Dis J. 2012 Jun;31(6):592-598.
Impact of HIV Severity on Cognitive and Adaptive Functioning During Childhood and Adolescence.
Smith R, Chernoff M, Williams PL, Malee KM, Sirois PA, Kammerer B, Wilkins M, Nichols S, Mellins C, Usitalo A, Garvie P, Rutstein R.
,University of Illinois at Chicago, Chicago, IL; Harvard School of Public Health; Northwestern University Feinberg School of Medicine, Chicago, IL; Tulane University Health Sciences Center, New Orleans, LA…
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/22592486.1
BACKGROUND: The influence of disease severity on cognitive and adaptive functioning in perinatally HIV-infected youth with (PHIV+/C) and without (PHIV+/NoC) a previous AIDS-defining illness (Centers for Disease Control and Prevention Class C event), compared with perinatally HIV-exposed but uninfected youth (PHEU) is not well understood.
METHODS: This was a cross-sectional analysis of cognitive and adaptive functioning in PHIV+/C (n = 88), PHIV+/NoC (n = 270) and PHEU (n = 200) youth aged 7-16 years, from a multisite prospective cohort study. Youth and caregivers completed the Wechsler Intelligence Scale for Children, Fourth Edition and the Adaptive Behavior Assessment System, Second Edition, respectively. We compared means and rates of impairment between groups, and examined associations with other psychosocial factors.
RESULTS: Overall mean scores on measures of cognitive and adaptive functioning were in the low average range for all 3 groups. After adjustment for covariates, mean full-scale intelligence quotient scores were significantly lower for the PHIV+/C group than the PHIV+/NoC and PHEU groups (mean = 77.8 versus 83.4 and 83.3, respectively), whereas no significant differences were observed between the PHEU and PHIV+/NoC groups in any domain. Lower cognitive performance for the PHIV+/C group was primarily attributable to a prior diagnosis of encephalopathy. No significant differences between groups were observed in adaptive functioning.
Conclusion: For long-term survivors, youth with HIV infection and a prior Centers for Disease Control and Prevention Class C event have higher risk for cognitive but not adaptive impairment regardless of current health status; this finding appears attributable to a previous diagnosis of encephalopathy. Early preventive therapy may be critical in reducing risk of later neurodevelopmental impairments.
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Soc Work Health Care. 2012 May;51(5):457-78.
HIV Positive Hispanic/Latinos Who Delay HIV Care: Analysis of Multilevel Care Engagement Barriers.
Keesee MS, Natale AP, Curiel HF.
Center for Spatial Analysis, University of Oklahoma, Norman, Oklahoma.
This article overviews a Health Resources and Services Administration (HRSA) study with a sample population consisting of 470 Hispanic/Latino persons living with HIV/AIDS who received primary HIV/AIDS medical services from one of five HRSA Special Projects of National Significance (SPNS) Border Health demonstration projects. The study purpose was to identify multilevel barriers that affect delayed entry into HIV/AIDS medical care among Hispanic/Latino persons living along the U.S.-Mexico border. Multilevel variables along individual, community/cultural, and structural/systems were assessed relative to delayed care entry. The results of this examination indicate that individual and structural/system-level variables affect delayed care entry, whereas support was not found for community/cultural-level barriers. Study findings inform treatment engagement strategies aimed to decrease HIV disease progression by bringing Hispanic/Latinos into care sooner.
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J Acquir Immune Defic Syndr. 2012 May 15. [Epub ahead of print]
Comorbid diabetes and the risk of progressive chronic kidney disease in HIV-infected adults: Data from the Veterans Aging Cohort Study.
Medapalli R, Parikh CR, Gordon K, Brown ST, Butt AA, Gibert CL, Rimland D, Rodriguez-Barradas MC, Chang CC, Justice AC, He JC, Wyatt CM.
Mount Sinai School of Medicine, New York; Yale University and West Haven VA Medical Center, New Haven, CT; VA Healthcare Systems West Haven, West Haven, CT; James J. Peters VA Medical Center, Bronx, NY…
INTRODUCTION: Approximately 15% of HIV-infected individuals have comorbid diabetes. Studies suggest that HIV and diabetes have an additive effect on chronic kidney (CKD) progression; however, this observation may be confounded by differences in traditional CKD risk factors.
METHODS: We studied a national cohort of HIV-infected and matched HIV-uninfected individuals who received care through the Veterans Healthcare Administration. Subjects were divided into four groups based on baseline HIV and diabetes status, and the rate of progression to an estimated glomerular filtration rate (eGFR) < 45ml/min/1.73m was compared using Cox-proportional hazards modeling to adjust for CKD risk factors.
RESULTS: 31,072 veterans with baseline eGFR ≥ 45ml/min/1.73m (10,626 with HIV only, 5,088 with diabetes only, and 1,796 with both) were followed for a median of 5 years. Mean baseline eGFR was 94ml/min/1.73m, and 7% progressed to an eGFR < 45ml/min/1.73m. Compared to those without HIV or diabetes, the relative rate of progression was increased in individuals with diabetes only [adjusted hazard ratio (HR) 2.48; 95% confidence interval (CI) 2.19-2.80], HIV only [HR 2.80, 95% CI 2.50-3.15], and both HIV and diabetes [HR 4.47, 95% CI 3.87-5.17].
DISCUSSION: Compared to patients with only HIV or diabetes, patients with both diagnoses are at significantly increased risk of progressive CKD even after adjusting for traditional CKD risk factors. Future studies should evaluate the relative contribution of complex comorbidities and accompanying polypharmacy to the risk of CKD in HIV-infected individuals, and prospectively investigate the use of cART, glycemic control, and adjunctive therapy to delay CKD progression.
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J Int Assoc Physicians AIDS Care (Chic). 2012 May 15. [Epub ahead of print]
Client Satisfaction with HIV Counseling Services: A Cross-Sectional Study from South India.
Papanna MK, Kumar P, Shetty A, Kamath A, Bhaskaran U, Sahoo S.
Department of Community Medicine, Kasturba Medical College (Manipal University), Mangalore, India.
Abstract: http://jia.sagepub.com/content/early/2012/05/11/1545109712444754.abstract
Background: Client satisfaction is a good predictor of performance of health programs. Hence, clients’ perception and satisfaction studies provide insight to improve the program.
PURPOSE: To assess clients’ perception and satisfaction with Integrated Counselling and Testing Centres (ICTCs) for HIV in an operational setting.
METHODS: A total of 191 client exit interviews from 12 ICTCs. The clients were stratified into general and antenatal clients. A systematic random sampling was done at high client load centers.
RESULTS: Cumulative client satisfaction was found to be 60% (±24%). Most of the clients (76%) agreed that counseling cleared doubts about HIV and found counseling beneficial (71%). Only 32% of the clients could recall issues discussed during the sessions. However, 92.5% were satisfied with ICTC facilities. Conclusions: Poor perception and low satisfaction with ICTCs needs to be addressed as this could have a direct bearing on the program.
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J Acquir Immune Defic Syndr. 2012 May 15. [Epub ahead of print]
Time to Initiate Antiretroviral Therapy between 4 Weeks and 12 Weeks of Tuberculosis Treatment in HIV-infected Patients: Results from the TIME Study.
Manosuthi W, Mankatitham W, Lueangniyomkul A, Thongyen S, Likanonsakul S, Suwanvattana P, Thawornwan U, Suntisuklappon B, Nilkamhang S, Sungkanuparph S; for the TIME Study Team.
Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi, Thailand; Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
BACKGROUND: Optimal timing for initiation of antiretroviral therapy (ART) among HIV-infected patients with tuberculosis (TB) is not well established.
METHODS: HIV/TB co-infected patients were randomized to initiate tenofovir/lamivudine/efavirenz at 4 weeks (4-week group) or 12 weeks (12-week group) of TB treatment. The primary outcome was 1-year all-cause mortality.
RESULTS: Of 156 patients, 79 were in 4-week group and 77 in 12-week group. Overall median (IQR) CD4 was 43 (47-106) cells/mm and median (IQR) HIV-1 RNA was 5.8 (5.4-6.3) log copies/mL. Eleven (7%) mortalities occurred in a total follow-up period of 137 patient-years. Seven percent (6/79, 8.76 per 100 patient-years) mortalities were in 4-week group and 6% (5/77, 7.25 per 100 person-years) mortalities were in 12-week group (RR=0.845, 95%CI=0.247-2.893). Twenty-eight (35%) patients in 4-week group and 25 (32%) patients in 12-week group were hospitalized (RR=1.142, 95%CI=0.588-2.217). Grade 2-4 adverse events were 39% (31/79) in 4-week group and 34% (26/77) in 12-week group (RR=1.267, 95%CI=0.659-2.435). In multivariate analysis, ‘low albumin’ (RR=2.695, 95%CI=1.353-5.475) and ‘low baseline CD4 count’ (RR=4.878, 95%CI=1.019-23.256) were the independent predictors of mortality. IRIS was more frequent in 4-week group with an incidence of 8.86 vs. 5.02 per 100 person-months in 12-week group over the first 6 months of ART (P=0.069).
CONCLUSIONS: In middle-income countries where ART is initiated at CD4 count of <350 cells/mm, immediate initiation of ART in HIV-infected patients with active TB was not associated with survival advantage when compared to initiation of ART at 12 weeks.
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J Acquir Immune Defic Syndr. 2012 May 15. [Epub ahead of print]
Potential cardiovascular disease risk markers among HIV-infected women initiating antiretroviral treatment.
Kaplan RC, Landay AL, Hodis HN, Gange SJ, Norris PJ, Young M, Anastos K, Tien PC, Xue X, Lazar J, Parrinello CM, Benning L, Tracy RP.
Albert Einstein College of Medicine; Rush University Medical Center; University of Southern California; Johns Hopkins Bloomberg School of Public Health…
BACKGROUND: Inflammation and hemostasis perturbation may be involved in vascular complications of HIV infection. We examined atherogenic biomarkers and subclinical atherosclerosis in HIV-infected adults before and after beginning highly-active antiretroviral therapy (HAART).
METHODS: In the Women’s Interagency HIV Study (WIHS), 127 HIV-infected women studied pre- and post-HAART were matched to HIV-uninfected controls. Six semi-annual measurements of soluble CD14, tumor necrosis factor (TNF)-alpha, soluble interleukin (IL)-2 receptor, IL-6, IL-10, monocyte chemoattractant protein (MCP)-1, D-dimer, and fibrinogen were obtained. Carotid artery intima-media thickness (CIMT) was measured by B-mode ultrasound.
RESULTS: Relative to HIV-uninfected controls, HAART-naïve HIV-infected women had elevated levels of soluble CD14 (1945 vs 1662 ng/mL, Wilcoxon signed rank P<0.0001), TNF-alpha (6.3 vs 3.4 pg/mL, P<0.0001), soluble IL-2 receptor (1587 vs 949 pg/mL, P<0.0001), IL-10 (3.3 vs 1.9 pg/mL, P<0.0001), MCP-1 (190 vs 163 pg/mL, P<0.0001) and D-dimer (0.43 vs 0.31 μg/mL, P<0.01). Elevated biomarker levels declined after HAART. While most biomarkers normalized to HIV-uninfected levels, in women on effective HAART, TNF-alpha levels remained elevated compared to HIV-uninfected women (+0.8 pg/mL, P=0.0002). Higher post-HAART levels of soluble IL-2 receptor (P=0.02), IL-6 (P=0.05), and D-dimer (P=0.03) were associated with increased CIMT.
CONCLUSIONS: Untreated HIV infection is associated with abnormal hemostasis (e.g., D-dimer), and pro-atherogenic (e.g., TNF-alpha) and anti-atherogenic (e.g., IL-10) inflammatory markers. HAART reduces most inflammatory mediators to HIV-uninfected levels. Increased inflammation and hemostasis are associated with subclinical atherosclerosis in recently treated women. These findings have potential implications for long-term risk of cardiovascular disease in HIV-infected patients, even with effective therapy.
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Arq Bras Endocrinol Metabol. 2012 Mar;56(2):137-41.
Prevalence of obesity and cardiovascular risk in patients with HIV/AIDS in Porto Alegre, Brazil.
Kroll AF, Sprinz E, Leal SC, Labrêa Mda G, Setúbal S.
Programa de Pós-Graduação em Ciências Médicas, Universidade Federal Fluminense, Niterói, RJ, Brazil.
Free PDF: http://www.scielo.br/pdf/abem/v56n2/07.pdf
Abstract:
OBJECTIVE: The aim of this study was to discover the prevalence of overweight, obesity and cardiovascular risk in our HIV/AIDS outpatients according to sex, antiretroviral therapy and other variables.
SUBJECTS AND METHODS: Patients underwent an anthropometric assessment. Body mass index and waist circumference were used to classify their nutritional status and their cardiovascular risk.
RESULTS: The majority of the 345 patients (58.8%) were males. Obesity was detected in 8.3% of them; 34.2% were overweight, and 5.2% malnourished. Near half of them (51.3%) had some cardiovascular risk, with increased risk in 24.6% of them, and substantially increased risk in 26.7% of them.
CONCLUSIONS: Overweight and obesity were highly prevalent. Women were more frequently obese (OR = 3.53; IC 95%, 1.47 < OR < 8.69), and their cardiovascular risk was often higher (OR = 6.97; IC 95%, 4.16 < OR < 11.76). The prevalence of obesity and cardiovascular risk did not change according to antiretroviral therapy or other variables.
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Int J Tuberc Lung Dis. 2012 May 7. [Epub ahead of print]
Assessing capacity for diagnosing tuberculosis in children in sub-Saharan African HIV care settings [Short communication].
Reid MJ, Saito S, Fayorsey R, Carter RJ, Abrams EJ.
Abstract: http://www.ingentaconnect.com/content/iuatld/ijtld/pre-prints/ijtld110816
Research on the prevalence of pediatric-specific tuberculosis (TB) diagnostics in sub-Saharan Africa is scarce. We assessed the availability of pediatric TB diagnostic tests at 651 pediatric human immunodeficiency virus care and treatment sites across nine African countries: 54% of the sites had access to sputum culture capacity and 51% to chest X-ray services. While 87% of sites had access to smear microscopy, only 6% had the capacity to perform sputum induction and 5% to perform gastric aspirate. These findings confirm that diagnostic resources for the accurate diagnosis of pediatric TB are limited. Capacity-building initiatives to improve sputum collection in children are urgently required.
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J Antimicrob Chemother. 2012 May 15. [Epub ahead of print]
High frequency of vitamin D deficiency in HIV-infected patients: effects of HIV-related factors and antiretroviral drugs.
Allavena C, Delpierre C, Cuzin L, Rey D, Viget N, Bernard J, Guillot P, Duvivier C, Billaud E, Raffi F.
Maladies Infectieuses et Tropicales, CHU Nantes, Nantes, France.
Abstract: http://jac.oxfordjournals.org/content/early/2012/05/15/jac.dks176.abstract
OBJECTIVES: The aim of this study was to assess 25-hydroxyvitamin D (vitamin D) status in an HIV-infected adult population and to define HIV- and antiretroviral-related factors associated with vitamin D deficiency.
METHODS: Using data from a prospective cohort of HIV-infected adult patients followed in five French centres (Dat’AIDS cohort), we evaluated the prevalence of vitamin D deficiency/insufficiency (<30 ng/mL). A multiple linear regression model was used to examine risk factors for vitamin D deficiency (≤10 ng/mL).
RESULTS: Vitamin D deficiency/insufficiency was observed in 86.7% of the 2994 patients, including 55.6% with vitamin D insufficiency and 31.1% with vitamin D deficiency. In multivariate analysis, factors associated with vitamin D deficiency were current smoking [adjusted OR (aOR) 1.55], estimated glomerular filtration rate ≥90 mL/min/1.73 m(2) (aOR 1.51), vitamin D measurement not performed in summer (aOR 0.27), CD4 <350 cells/mm(3) (aOR 1.37 for CD4 200 to <350 and 1.62 for CD4 <200 cells/mm(3)) and antiretroviral therapy (aOR 2.61). Gender, body mass index, age, coinfection and previous AIDS were not associated factors. In the antiretroviral-treated population (n = 2660), besides the same factors found in the whole population, efavirenz was the only drug to be significantly associated with deficiency, with an aOR of 1.89 (95% CI 1.45-2.47).
CONCLUSIONS: Vitamin D deficiency is frequent in this HIV-infected population. Patients on antiretroviral therapy are at higher risk of vitamin D deficiency than antiretroviral-naive patients, with an increased risk in patients receiving efavirenz. No effect of the other antiretrovirals, including the latest (etravirine, darunavir, raltegravir), was found.
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Nicotine Tob Res. 2012 May 15. [Epub ahead of print]
Safety of Varenicline Among Smokers Enrolled in the Lung HIV Study.
Ferketich AK, Diaz P, Browning KK, Lu B, Koletar SL, Reynolds NR, Wewers ME.
The Ohio State University College of Public Health, Columbus,OH. aferketich@cph.osu.edu.
Abstract: http://ntr.oxfordjournals.org/content/early/2012/05/15/ntr.nts121.abstract
INTRODUCTION: The prevalence of smoking is high among the human immunodeficiency virus (HIV)-infected population, yet there are few studies of tobacco dependence treatment in this population. This paper reports the safety of varenicline versus nicotine replacement therapy (NRT) and describes preliminary results about the effectiveness of varenicline versus NRT in HIV-infected smokers.
METHODS: Participants completed 12 weeks of telephone counseling and either varenicline or NRT. Varenicline was encouraged as the preferred intervention; NRT was used for those unable/unwilling to take varenicline. Adverse events (AEs), related to pharmacotherapy, were monitored. Biochemically confirmed abstinence at 3 months was examined. Inverse probability of treatment weighted logistic regression models was fit to compare participants on varenicline to those on NRT.
RESULTS: Among participants on varenicline (n = 118), the most common AEs were nausea, sleep problems, and mood disturbances. One person reported suicidal ideation; there were no cardiovascular complications. There were no differences in the varenicline AE profile between participants on combination antiretroviral therapy (ART) and those not on ART. The percentages of confirmed abstainers were 11.8% in the NRT group and 25.6% in the varenicline group. The odds of being abstinent were 2.54 times as great in the varenicline group compared with the NRT group in the propensity weighted model (95% CI 1.43-4.49).
Conclusions:In this preliminary study, the safety profile of varenicline among HIV-infected smokers resembles findings among smokers without HIV. In addition, varenicline may be more effective at promoting abstinence in this population. Future randomized clinical trials are warranted.
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Paediatr Int Child Health. 2012;32(2):74-81.
Nutritional status and its response to treatment of children, with and without HIV infection, hospitalized for the management of tuberculosis.
Schaaf HS, Cilliers K, Willemse M, Labadarios D, Kidd M, Donald PR.
Stellenbosch University, Cape Town, South Africa.
Abstract: http://www.ingentaconnect.com/content/maney/pch/2012/00000032/00000002/art00003
BACKGROUND: The association of childhood tuberculosis (TB) and malnutrition is known, but treatment response, the influence of the acute-phase response (APR) and concomitant HIV infection are not well documented.
AIM: To evaluate the nutritional response and APR in HIV-infected and uninfected children hospitalised for the treatment of TB and receiving standard anti-tuberculosis chemotherapy.
METHODS: During a study of the pharmacokinetics of standard anti-tuberculosis agents, anthropometric parameters were measured and blood concentrations of nutrients and C-reactive protein (CRP) determined at 1 and 4 months after initiation of chemotherapy.
RESULTS: 24 HIV-infected and 34 HIV-uninfected children were studied. On enrolment, 31·6% of HIV-infected and 2·9% of HIV-uninfected children were underweight, and 31·6% and 14·7%, respectively, were stunted. Mean values of weight, height/length, head circumference and mid-upper-arm circumference on enrolment and at 4-month assessment in HIV-infected and uninfected children did not differ. Mean triceps skinfold (TSF) (8·17 and 9·73 cm) and subscapular skinfold (SSF) thicknesses (5·75 and 7·5 cm) on enrolment differed significantly (P = 0·03 and P = 0·003); by 4 months, TSF had declined to 5·97 cm (P<0·001) and 8·87 cm (P = 0·05), respectively, and SSF to 5·57 cm (P = 0·79) and 6·73 cm (P = 0·04); the arm muscle area (AMA) was low in a majority of children on enrolment and remained so at the second assessment. CRP was raised in 66·6% and 53·3% of HIV-infected and -uninfected children on enrolment, but at 4-month assessment was raised in 63·2% and 15·2%, respectively. Other micronutrient and haematological findings probably reflect an APR, but no children had sub-normal zinc or magnesium values; most selenium and vitamin C and E values were normal. An elevated platelet count (>420×10(9)/L) was significantly more common in HIV-uninfected children, and was still raised in 39% at 4 months.
CONCLUSION: A majority of HIV-infected and uninfected children had an APR but it had resolved by 4 months in most HIV-uninfected children. In both groups, low and declining skinfolds and a persistently low AMA indicate a persistent disturbance of fat and protein metabolism, despite successful chemotherapy.
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Am J Public Health. 2012 May 17. [Epub ahead of print]
Oliver Mtukudzi’s Musical Approach to HIV/AIDS.
Kyker JW.
Jennifer W. Kyker is Associate Professor of Musicology at the Eastman School of Music, University of Rochester, Rochester, NY.
EMBODYING MULTIPLE DIS-courses of HIV/AIDS within a single image, this 2008 calendar was designed by Population Services International (PSI) and distributed in partnership with the Zimbabwean Ministry of Health and Child Welfare. Within it, the renowned popular musician Oliver Mtukudzi, acoustic guitar in hand, figures as a benevolent presence keeping musical watch over a real-life couple, fêted as the millionth client to access the voluntary testing and counseling services offered through PSI’s network of New Start Centres. Pairing ordinary individuals with an exceptional role model, this everyday image conveys public health messages about the importance of voluntary counseling and testing, yet simultaneously invokes Mtukudzi’s distinctive musical approach to the HIV/AIDS crisis.
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Clinical/Basic Science: HIV+ BIOMED: Immun., Vaccine, Virol., Pathology RELATED ARTICLE SUMMARIES
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Nephrol Dial Transplant. 2012 May 13. [Epub ahead of print]
HIV-associated nephropathy: a diagnosis in evolution.
Ray PE.
Research Center for Molecular Physiology, Division of Nephrology, Children’s National Medical Center, Washington, DC.
Abstract: http://ndt.oxfordjournals.org/content/early/2012/05/13/ndt.gfs114.abstract
HIV-1 associated nephropathy (HIVAN) is a clinical and renal histological disease characterized by the presence of heavy proteinuria associated with focal segmental glomerulosclerosis and microcystic tubular dilatation. These renal lesions lead to renal enlargement and rapid progression to kidney failure. People from African ancestry show a unique susceptibility to develop HIVAN. The study by Wearne and colleagues, which includes the largest group of patients of African ancestry with HIVAN studied so far, describes a novel renal histological variant of HIVAN, and suggests that antiretroviral therapies improve the clinical outcome of all HIV-associated renal diseases. These findings, when interpreted in the context of recent advances in our understanding of the molecular pathogenesis and genetics of HIVAN, will facilitate the recognition of all clinical variants of HIVAN as well the planning of better screening, prevention, and treatment programs for all HIV nephropathies.
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PLoS One. 2012;7(5):e36438. Epub 2012 May 9.
International Network for Comparison of HIV Neutralization Assays: The NeutNet Report II.
Heyndrickx L, Heath A, Sheik-Khalil E, Alcami J, Bongertz V, Jansson M, Malnati M, Montefiori D, Moog C, Morris L, Osmanov S, Polonis V, Ramaswamy M, Sattentau Q, Tolazzi M, Schuitemaker H, Willems B, Wrin T, Fenyö EM, Scarlatti G.
Virology Unit, Biomedical Department, Institute of Tropical Medicine, Antwerp, Belgium.
Free HTML/Link to Free PDF: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0036438
Abstract:
BACKGROUND: Neutralizing antibodies provide markers for vaccine-induced protective immunity in many viral infections. By analogy, HIV-1 neutralizing antibodies induced by immunization may well predict vaccine effectiveness. Assessment of neutralizing antibodies is therefore of primary importance, but is hampered by the fact that we do not know which assay(s) can provide measures of protective immunity. An international collaboration (NeutNet) involving 18 different laboratories previously compared different assays using monoclonal antibodies (mAbs) and soluble CD4 (Phase I study).
METHODS: In the present study (Phase II), polyclonal reagents were evaluated by 13 laboratories. Each laboratory evaluated nine plasmas against an 8 virus panel representing different genetic subtypes and phenotypes. TriMab, a mixture of three mAbs, was used as a positive control allowing comparison of the results with Phase I in a total of nine different assays. The assays used either uncloned virus produced in peripheral blood mononuclear cells (PBMCs) (Virus Infectivity Assays, VIA), or Env (gp160)-pseudotyped viruses (pseudoviruses, PSV) produced in HEK293T cells from molecular clones or from uncloned virus. Target cells included PBMC and genetically engineered cell lines in either single- or multiple-cycle infection format. Infection was quantified by using a range of assay read-outs including extra- or intra-cellular p24 antigen detection, luciferase, beta-galactosidase or green fluorescent protein (GFP) reporter gene expression.
FINDINGS: Using TriMab, results of Phase I and Phase II were generally in agreement for six of the eight viruses tested and confirmed that the PSV assay is more sensitive than PBMC (p=0.014). Comparisons with the polyclonal reagents showed that sensitivities were dependent on both virus and plasma.
CONCLUSIONS: Here we further demonstrate clear differences in assay sensitivities that were dependent on both the neutralizing reagent and the virus. Consistent with the Phase I study, we recommend parallel use of PSV and VIA for vaccine evaluation.
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Cell Microbiol. 2012 May 14. [Epub ahead of print]
The molecular basis of HIV entry.
Klasse PJ.
Department of Microbiology and Immunology, Cornell University, Weill Cornell Medical College, New York, NY.
Infection by HIV starts when the virus attaches to a susceptible cell. For viral replication to continue, the viral envelope must fuse with a cellular membrane, thereby delivering the viral core to the cytoplasm, where the RNA genome is reverse-transcribed. The key players in this entry by fusion are the envelope glycoprotein, on the viral side, and CD4 and a co-receptor, CCR5 or CXCR4, on the cellular side. Here, the interplay of these molecules is reviewed from cell-biological, structural, mechanistic, and modeling-based perspectives. Hypotheses are evaluated regarding the cellular compartment for entry, the transfer of virus through direct cell-to-cell contact, the sequence of molecular events, and the number of molecules involved on each side of the virus-cell divide. An emerging theme is the heterogeneity among the entry mediators on both sides, a diversity that affects the efficacy of entry inhibitors, be they small-molecule ligands, peptides, or neutralizing antibodies. These insights inform rational strategies for therapy as well as vaccination.
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Expert Opin Biol Ther. 2012 May 15. [Epub ahead of print]
Improved Outlook on HIV-1 Prevention and Vaccine Development.
Vasan S, Michael NL.
U.S. Military HIV Research Program (MHRP), Armed Forces Research Institute of Medical Sciences (AFRIMS) , Bangkok , Thailand; nmichael@hivresearch.org.
Abstract: http://informahealthcare.com/doi/abs/10.1517/14712598.2012.688020
The development of an effective vaccine against HIV-1 has been challenging but recent advances in both the HIV prevention landscape and the partial efficacy of the recent RV144 vaccine efficacy trial in Thailand provide hope for an improved arsenal of approaches to prevent HIV-1 transmission. Areas covered: This review describes recent advances in HIV-1 prevention such as circumcision, microbicides and pre-exposure prophylaxis with antiretroviral therapy, but focuses mainly on the current state of HIV-1 vaccine development in the post-RV144 era. Expert opinion: The field of HIV-1 vaccine development has been plagued by the unprecedented challenges involved with designing a vaccine effective in preventing transmission of a retrovirus, due in part to sequence diversity, retroviral integration into host chromosomes, establishment of reservoir sites and glycosylation shielding of the HIV-1 envelope. The partial efficacy of the recent RV144 vaccine trial in Thailand may allow for better understanding of immune correlates of infection risk, which could enable iterative improvements to vaccine regimens in the development pipeline. In parallel, a number of promising vaccine strategies incorporating viral vectors, novel immunogens, delivery systems and adjuvants are advancing in clinical development. Vaccine development must occur in parallel with continued advances in HIV-1 prevention.
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J Neurovirol. 2012 May 15. [Epub ahead of print]
Cerebrovascular risk factors and brain microstructural abnormalities on diffusion tensor images in HIV-infected individuals.
Nakamoto BK, Jahanshad N, McMurtray A, Kallianpur KJ, Chow DC, Valcour VG, Paul RH, Marotz L, Thompson PM, Shikuma CM.
University of Hawaii, Honolulu, HI, beau_nakamoto@yahoo.com.
Abstract: http://www.springerlink.com/content/0737n77v6u7345g0/
HIV-associated neurocognitive disorder remains prevalent in HIV-infected individuals despite effective antiretroviral therapy. As these individuals age, comorbid cerebrovascular disease will likely impact cognitive function. Effective tools to study this impact are needed. This study used diffusion tensor imaging (DTI) to characterize brain microstructural changes in HIV-infected individuals with and without cerebrovascular risk factors. Diffusion-weighted MRIs were obtained in 22 HIV-infected subjects aged 50 years or older (mean age=58 years, standard deviation = 6 years; 19 males, three females). Tensors were calculated to obtain fractional anisotropy (FA) and mean diffusivity (MD) maps. Statistical comparisons accounting for multiple comparisons were made between groups with and without cerebrovascular risk factors. Abnormal glucose metabolism (i.e., impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus) was associated with significantly higher MD (false discovery rate (FDR) critical p value = 0.008) and lower FA (FDR critical p value=0.002) in the caudate and lower FA in the hippocampus (FDR critical p value=0.004). Pearson correlations were performed between DTI measures in the caudate and hippocampus and age- and education-adjusted composite scores of global cognitive function, memory, and psychomotor speed. There were no detectable correlations between the neuroimaging measures and measures of cognition. In summary, we demonstrate that brain microstructural abnormalities are associated with abnormal glucose metabolism in the caudate and hippocampus of HIV-infected individuals. Deep gray matter structures and the hippocampus may be vulnerable in subjects with comorbid abnormal glucose metabolism, but our results should be confirmed in further studies.
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Viruses. 2012 Apr;4(4):488-520. Epub 2012 Apr 10.
Nanotechnology and the Treatment of HIV Infection.
Parboosing R, Maguire GE, Govender P, Kruger HG.
Department of Virology, National Health Laboratory Service/University of KwaZulu-Natal, c/o Inkosi Albert Luthuli Central Hospital, Mayville, Durban, South Africa.
Free PDF: http://www.mdpi.com/1999-4915/4/4/488/pdf
Abstract: http://www.mdpi.com/1999-4915/4/4/488
Suboptimal adherence, toxicity, drug resistance and viral reservoirs make the lifelong treatment of HIV infection challenging. The emerging field of nanotechnology may play an important role in addressing these challenges by creating drugs that possess pharmacological advantages arising out of unique phenomena that occur at the “nano” scale. At these dimensions, particles have physicochemical properties that are distinct from those of bulk materials or single molecules or atoms. In this review, basic concepts and terms in nanotechnology are defined, and examples are provided of how nanopharmaceuticals such as nanocrystals, nanocapsules, nanoparticles, solid lipid nanoparticles, nanocarriers, micelles, liposomes and dendrimers have been investigated as potential anti-HIV therapies. Such drugs may, for example, be used to optimize the pharmacological characteristics of known antiretrovirals, deliver anti-HIV nucleic acids into infected cells or achieve targeted delivery of antivirals to the immune system, brain or latent reservoirs. Also, nanopharmaceuticals themselves may possess anti-HIV activity. However several hurdles remain, including toxicity, unwanted biological interactions and the difficulty and cost of large-scale synthesis of nanopharmaceuticals.
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Expert Opin Pharmacother. 2012 May 17. [Epub ahead of print]
Darunavir : a nonpeptidic protease inhibitor for antiretroviral-naive and treatment-experienced adults with HIV infection.
Robertson J, Feinberg J.
University of Cincinnati, Division of Infectious Diseases, Cincinnati, OH feinbej@ucmail.uc.edu.
Abstract: http://informahealthcare.com/doi/abs/10.1517/14656566.2012.681776
Introduction: Darunavir , a nonpeptidic inhibitor of the HIV-1 protease with potent activity against resistant virus, was initially approved by the FDA (2006) and the EMA (2007) for the treatment of antiretroviral-experienced adults, and later for naive adults. Darunavir/ritonavir (600/100 mg twice daily, ideally given with two other active antiretrovirals) demonstrated superior efficacy compared to lopinavir/ritonavir and other protease inhibitors in highly experienced patients. Darunavir/ritonavir (800/100 mg once daily) was demonstrated to be safe and effective for the treatment of naive patients and those with limited darunavir resistance-associated mutations (RAMs). Because darunavir must be coadministered with ritonavir, cytochrome P450 drug-drug interactions can be problematic.
Areas covered: The chemistry, pharmacokinetics, pharmacodynamics, efficacy and safety of darunavir are reviewed in this paper. A PubMed search was conducted using the search terms ‘randomized’, ‘darunavir’ and ‘efficacy’. Review articles and studies that primarily focused on other drugs were excluded. Expert opinion: Because darunavir exhibits efficacy against virus with significant protease inhibitor resistance mutations, it is critically important in the treatment of experienced patients, although viral suppression rates may be lower in those with a high baseline viral load or a greater number of cumulative darunavir RAMs. Darunavir/ritonavir is efficacious and well tolerated as a once-daily regimen in naive patients.
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NEWS ITEMS
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FDA panel endorses ‘Quad’ pill for HIV
http://www.medpagetoday.com/HIVAIDS/HIVAIDS/32642
DATE: 11 May 2012
The FDA’s Antiviral Drugs Advisory Committee has voted 13 to 1 to recommend approval of Gilead Sciences’ new single-pill, once-daily regimen for HIV treatment. Known as the “quad” pill, it contains four drugs — two are widely used anti-HIV drugs, emtricitabine and tenofovir, and the other two, elvitegravir and cobicistat, are investigational. Gilead is seeking approval of the drug for use in treatment-naive HIV patients or in those previously treated but without resistance to any of the components. If the FDA follows the advice of the panel and approves the quad drug, it would be the third single-pill, once-daily complete regimen for HIV, along with Atripla (efavirenz, emtricitabine, and tenofovir) and Complera (rilpivirine, emtricitabine, and tenofovir). All four drugs in the quad pill are made by Gilead, which will seek separate approvals for each of the new drugs later, as stand-alone medications.
During its Friday meeting, the panel heard data from FDA reviewers about Gilead’s head-to-head trials against two other widely used HIV regimens, in which the quad pill demonstrated noninferiority in reducing viral loads to undetectable levels. The quad pill was tested against Atripla in one trial and against the ritonavir-boosted protease inhibitor atazanavir (Reyataz), combined with emtricitabine, and tenofovir, in another. In the first trial, 87.6% of quad pill patients reached an undetectable HIV viral load by the end of 48 weeks of therapy, compared with 84.1% of those taking Atripla. In the second trial, quad pill efficacy was 89.5% compared with 86.8% in the control arm. The safety of the drug was similar to the comparator drugs, although there seemed to be a disproportionate number of patients stopping therapy with the quad pill because of adverse renal events — an issue that caused FDA reviewers some concern. The adverse events included an increased frequency of proximal tubulopathies among quad pill patients, as well as more graded serum creatinine and urine protein abnormalities.
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FDA panel backs OraSure’s in-home HIV test
http://www.reuters.com/article/2012/05/15/us-usa-aids-orasure-idUSBRE84E1DJ20120515
DATE: 15 May 2012
US Food and Drug Administration panel of outside experts concluded that OraSure Technologies Inc’s over-the-counter, in-home HIV test is reasonably safe and effective for determining whether someone has the AIDS virus. The 17-member FDA advisory committee voted unanimously that the drug’s ability to prevent new HIV infections and provide HIV-positive people with access to medical care and social services outweighed the risks of false results. Tuesday’s recommendations will now be considered by agency regulators as they determine whether the product, known as the OraQuick In-Home HIV Test, should be approved as the first-ever over-the-counter, completely in-home HIV test.
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Taking Truvada to prevent HIV also comes with risks
DATE: 14 May 2012
A panel of advisers to the Food and Drug Administration took a historic step last week when they recommended that the agency for the first time approve a drug that healthy people can take once a day to prevent HIV infection. Such a pill has long been a goal of research, something that might help stem a global epidemic that is still causing two million new worldwide cases each year, including 50,000 in the United States.
But the panel members worried about how to make sure doctors and patients would use the drug correctly. Otherwise, they said, the potential harm could be huge – not just to those taking the pill, but also to their sexual partners. Approval of the first HIV preventive has tangled experts in complicated scientific and psychological issues and brought sometimes furious debate. One side says people are so unlikely to use the drug properly that it is irresponsible and dangerous to let them have it. The other side calls that argument paternalistic and says people who are motivated to protect themselves should be given the tools to do so. The drug is Truvada, which contains two antivirals and is already approved and widely used in combination with other drugs to treat HIV infection. In the last few years, studies have shown that taking Truvada alone every day can prevent infection. If approved, the drug would be recommended for HIV-negative people at high risk of becoming infecte d, like gay men who have multiple partners and do not use condoms consistently, prostitutes and people in relationships with someone who is HIV-positive.
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Botswana makes new pitch for circumcision in AIDS fight
14 May 2012
A government campaign to thwart the spread of HIV by circumcising nearly half a million Botswana males has managed to reach just 7 percent since it began three years ago. Other southern African countries also have launched national male circumcision campaigns, including Lesotho, Swaziland, Zambia, and Zimbabwe; all are well below their targets. There is no tradition of male circumcision in Botswana. Though the procedure is performed with local anesthetic, takes only a few minutes, and has a recovery period of just a few days, fears persist. “The greatest challenge that we have is the fear of pain amongst men, hence we are having a low turn-out,” said Conrad Ntsuape, the effort’s coordinator. “Most men seem to think the pain from the procedure might take long to heal and force them to stay away from school or work for long, but we are still intensifying our education campaign.” Alan Whiteside of the University of KwaZulu-Natal in South Africa said uptake is lagging in many countries across the region. “The problem is not so much that people don’t want to embrace circumcision, it is because sometimes the programs are implemented without the necessary ground work and community participation,” the health economist said. In response, Botswana is launching new advertisements promoting “safe male circumcision” as a lifeline and enlisting the support of popular musicians.
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CDC Proposes that All Baby Boomers Be Tested Once for Hepatitis C
MAY-18-12 The Centers for Disease Control and Prevention issued draft guidelines proposing that all U.S. baby boomers get a one-time test for the hepatitis C virus. One in 30 baby boomers – the generation born from 1945 through 1965 – has been infected with hepatitis C, and most don’t know it. Hepatitis C causes serious liver diseases including liver cancer, which is the fastest-rising cause of cancer-related deaths, and the leading cause of liver transplants in the United States. Click here to read the full press release from the CDC.
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Science. 2012 May 18;336(6083):792.
AIDS research. FDA panel recommends anti-HIV drug for prevention.
Cohen J.
News Item: http://www.sciencemag.org/content/336/6083/792.short
Excerpt
On 10 May, the Antiviral Drugs Advisory Committee of the U.S. Food and Drug Administration (FDA) held a marathon debate about whether an anti-HIV drug on the market as a treatment should receive approval as a preventive for uninfected people. For more than 12 hours, the committee heard scientific evidence and impassioned arguments for and against, ultimately recommending that FDA approve the use of the drug Truvada for what’s called pre-exposure prophylaxis (PrEP). The decision was not unanimous, and there was a protracted back and forth about how to reduce the possibility that PrEP might cause more harm than good…
