NOTE: Lserv posted at www.RobertMalow.org. Any questions concerning the Lserv (e.g. content valuable to post, literature queries, etc.) should be emailed to my graduate assistant, Jennifer Attonito at firstname.lastname@example.org with the subject line “Lserv comment”. For subscribing/unsubscribing to the Lserv, go to: http://listserv.fiu.edu/archives/ hiv.html. Click “Join or Leave HIV.” Enter ‘Name’ and ‘Email Address’ (do not change other webpage settings) then click on ‘Join HIV’ button to subscribe or on “Leave HIV” button to unsubscribe.
69. The MONET trial: week 144 analysis of the efficacy of darunavir/ritonavir (DRV/r) monotherapy versus DRV/r plus two nucleoside reverse transcriptase inhibitors, for patients with viral load < 50 HIV-1 RNA copies/mL at baseline.
Misc- Policy, Reviews/MetaAnalyses, Structural/Scale-up/Country Level Translation/Intervention, Economic/Health Disparities/Soc.Justice/Human Rights Issues
In July 2012, the International AIDS Conference returns to the U.S. for the first time in 22 years thanks to the administration’s lifting of the travel ban on persons living with HIV. With over 25,000 researchers, advocates, government officials, journalists, non-governmental organization service providers, clinicians, health department staff, people living with HIV and other committed persons waiting anxiously to hear what President Obama (or the administration’s representative) says at the meeting, we must urgently consider what preparations the U.S. needs to make for this global stage. Here, I focus on issues related to HIV in the U.S. because the conference traditionally spotlights the epidemic in the host country. We have serious policy and programmatic work to do to get our house in order before the world comes to our door.
The president is clearly interested in HIV/AIDS. On July 13, 2010, he released the National HIV/AIDS Strategy (NHAS), and challenged the country, saying, “So the question is not whether we know what to do, but whether we will do it.” This landmark comprehensive HIV plan includes five-year goals regarding HIV prevention, care, housing, program coordination and health disparities (highlighting especially the disproportionate burden of HIV among gay men of all races and ethnicities, and in African American and Latino/Latina communities). But in the past 20 months roadblocks have emerged, and we have real hurdles to overcome quickly to stay on track for NHAS progress; it will be critical for the administration to address these challenges before the conference. I describe below some challenges I believe are critical…
1. Acknowledging That Care Needs Are Larger Than Commonly Perceived.
2. “The Beginning of the End of AIDS.”… if we mean to make the investments to achieve it.
3. Price Tag.
4. HIV Is Transmitted By Human Behavior — You Might Have To Say “Sex.”
5. Initial Amendments to the NHAS.
6. Measuring Progress.
Holtgrave DR, Maulsby C, Kharfen M, Jia Y, Wu C, Opoku J, West T, Pappas G.
Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Suite 280, Baltimore, MD, 21205, USA, email@example.com.
A retrospective economic evaluation of a female condom distribution and education program in Washington, DC. was conducted. Standard methods of cost, threshold and cost-utility analysis were utilized as recommended by the U.S. Panel on cost-effectiveness in health and medicine. The overall cost of the program that distributed 200,000 female condoms and provided educational services was $414,186 (at a total gross cost per condom used during sex of $3.19, including educational services). The number of HIV infections that would have to be averted in order for the program to be cost-saving was 1.13 in the societal perspective and 1.50 in the public sector payor perspective. The cost-effectiveness threshold of HIV infections to be averted was 0.46. Overall, mathematical modeling analyses estimated that the intervention averted approximately 23 HIV infections (even with the uncertainty inherent in this estimate, this value appears to well exceed the necessary thresholds), and the intervention resulted in a substantial net cost savings.
Journal of the International Association of Physicians in AIDS Care
(JIAPAC) OnlineFirst Alert
HIV-Related Stigma, Isolation, Discrimination, and Serostatus Disclosure: A Global Survey of 2035 HIV-Infected Adults
Jean B. Nachega, Chelsea Morroni, Jose M. Zuniga, Renslow Sherer, Chris Beyrer, Suniti Solomon, Mauro Schechter, and Jurgen Rockstroh J Int Assoc Physicians AIDS Care (Chic Ill) published 19 March 2012,
Background: Little is known globally about the perspectives of people living with HIV/AIDS (PLWHA) on perceived HIV-related stigma and its consequences. Methods: Cross-sectional study (January-March 2010) of perceived HIV-related stigma among PLWHA (N = 2035) using a standardized questionnaire. Findings: Thirty-seven percent of respondents reported loneliness as a result of their HIV status. Depression was reported by 27%. While 96% reported disclosing their HIV status to at least 1 person, 17% of patients who reported being in a long-term sexual relationship had not disclosed their status to their partner. Variables associated with perceived stigma were living in Asia-Pacific versus other regions (odds ratio [OR]: 2.77; 95% confidence interval [CI] 1.96-3.92); having experienced body/face changes; reported depression (OR: 1.25; 95% CI 1.11-1.38); and nondisclosure of HIV status (OR: 1.75; 95% CI 1.28-2.41). Conclusion: Thirty years into the HIV pandemic, perceived HIV stigma, isolation, and discrimination persist and are associated with loneliness and depression among PLWHA.
AIDS Behav. 2012 Mar 20. [Epub ahead of print]
Streaming Weekly Soap Opera Video Episodes to Smartphones in a Randomized Controlled Trial to Reduce HIV Risk in Young Urban African American/Black Women.
Jones R, Lacroix LJ.
College of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, firstname.lastname@example.org.
Abstract/1st page image: http://www.springerlink.com/content/j5p8785650w3uh67/
Love, Sex, and Choices is a 12-episode soap opera video series created as an intervention to reduce HIV sex risk. The effect on women’s HIV risk behavior was evaluated in a randomized controlled trial in 238 high risk, predominately African American young adult women in the urban Northeast. To facilitate on-demand access and privacy, the episodes were streamed to study-provided smartphones. Here, we discuss the development of a mobile platform to deliver the 12-weekly video episodes or weekly HIV risk reduction written messages to smartphones, including; the technical requirements, development, and evaluation. Popularity of the smartphone and use of the Internet for multimedia offer a new channel to address health disparities in traditionally underserved populations. This is the first study to report on streaming a serialized video-based intervention to a smartphone. The approach described here may provide useful insights in assessing advantages and disadvantages of smartphones to implement a video-based intervention.
Bull World Health Organ. 2012 Feb 1;90(2):128-138C
Effect of cotrimoxazole on mortality in HIV-infected adults on antiretroviral therapy: a systematic review and meta-analysis.
Suthar AB, Granich R, Mermin J, Van Rie A.
OBJECTIVE: To determine whether cotrimoxazole reduces mortality in adults receiving antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection in low- and middle-income countries through a systematic review and meta-analysis.
METHODS: PubMed and Embase were searched for randomized controlled trials and prospective and retrospective cohort studies that compared mortality or morbidity in HIV-infected individuals aged ≥ 13 years on cotrimoxazole and ART and on ART alone. The Newcastle-Ottawa Quality Assessment Scale was used to assess selection, confounding and measurement bias. Publication bias was assessed using Egger’s and Begg’s tests. Sensitivity analysis was performed because the I-squared statistic indicated substantial heterogeneity in study results. A random-effects model was used for meta-analysis.
FINDINGS: Nine studies were included. Begg and Egger P-values for the seven that reported the effect of cotrimoxazole on mortality were 0.29 and 0.49, respectively, suggesting no publication bias. The I-squared statistic was 93.2%, indicating high heterogeneity in study results. The sensitivity analysis showed that neither the follow-up duration nor the percentage of individuals with World Health Organization stage 3 or 4 HIV disease at baseline explained the heterogeneity. The summary estimate of the effect of cotrimoxazole on the incidence rate of death was 0.42 (95% confidence interval: 0.29-0.61). Since most studies followed participants for less than 1 year, it was not possible to determine whether cotrimoxazole can be stopped safely after ART-induced immune reconstitution.
CONCLUSION: Cotrimoxazole significantly increased survival in HIV-infected adults on ART. Further research is needed to determine the optimum duration of cotrimoxazole treatment in these patients.
J Med Ethics. 2012 Mar 19. [Epub ahead of print]
The rights and wrongs of intentional exposure research: contextualising the Guatemala STD inoculation study.
In its recent review of the US Public Health Service Sexually Transmitted Disease Inoculation Study, conducted in Guatemala from 1946 to 1948, the Presidential Commission for the Study of Bioethical Issues identified a number of egregious ethical violations, but failed to adequately address issues associated with the intentional exposure research design in particular. As a result, a common public misconception that the study was wrong because researchers purposefully infected their subjects has been left standing. In fact, human subjects have been exposed to disease pathogens for experimental purposes for centuries, and this study design remains an important scientific tool today. It shares key features with other types of widely accepted research on human subjects and can be conducted ethically, provided certain safeguards are implemented. That these safeguards were not implemented in Guatemala is what made that study wrong, rather than the fact of intentional exposure itself. To preserve public trust in the clinical research enterprise, this conclusion ought to be stated explicitly and emphasised.
BMJ Open. 2012 Mar 15;2(2):e000195. Print 2012.
Introduction and evaluation of a ‘pre-ART care’ service in Swaziland: an operational research study.
Burtle D, Welfare W, Elden S, Mamvura C, Vandelanotte J, Petherick E, Walley J, Wright J.
Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
OBJECTIVE: To implement and evaluate a formal pre-antiretroviral therapy (ART) care service at a district hospital in Swaziland.
DESIGN: Operational research.
SETTING: District hospital in Southern Africa.
PARTICIPANTS: 1171 patients with a previous diagnosis of HIV. A baseline patient group consisted of the first 200 patients using the service. Two follow-up groups were defined: group 1 was all patients recruited from April to June 2009 and group 2 was 200 patients recruited in February 2010.
INTERVENTION: Introduction of pre-ART care-a package of interventions, including counselling; regular review; clinical staging; timely initiation of ART; social and psychological support; and prevention and management of opportunistic infections, such as tuberculosis. PRIMARY AND SECONDARY OUTCOME MEASURES: Proportion of patients assessed for ART eligibility, proportion of eligible patients who were started on ART and proportion receiving defined evidence-based interventions (including prophylactic co-trimoxazole and tuberculosis screening).
RESULTS: Following the implementation of the pre-ART service, the proportion of patients receiving defined interventions increased; the proportion of patient being assessed for ART eligibility significantly increased (baseline: 59%, group 1: 64%, group 2: 76%; p=0.001); the proportion of ART-eligible patients starting treatment increased (baseline: 53%, group 1: 81%, group: 2, 81%; p<0.001) and the median time between patients being declared eligible for ART and initiation of treatment significantly decreased (baseline: 61 days, group 1: 39 days, group 2: 14 days; p<0.001).
CONCLUSIONS: This intervention was part of a shift in the model of care from a fragmented acute care model to a more comprehensive service. The introduction of structured pre-ART was associated with significant improvements in the assessment, management and timeliness of initiation of treatment for patients with HIV.
BMC Med Res Methodol. 2012 Mar 14;12(1):30. [Epub ahead of print]
Effect of misclassification of antiretroviral treatment status on the prevalence of transmitted HIV-1 drug resistance.
Castro H, Pillay D, Sabin C, Dunn DT.
BACKGROUND: Estimates of the prevalence of transmitted HIV drug resistance (TDR) in a population are derived from resistance tests performed on samples from patients thought to be naive to antiretroviral treatment (ART). Much of the debate over reliability of estimates of the prevalence of TDR has focused on whether the sample population is representative. However estimates of the prevalence of TDR will also be distorted if some ART-experienced patients are misclassified as ART-naive.
METHODS: The impact of misclassification bias on the rate of TDR was examined. We developed methods to obtain adjusted estimates of the prevalence of TDR for different misclassification rates, and conducted sensitivity analyses of trends in the prevalence of TDR over time using data from the UK HIV Drug Resistance Database. Logistic regression was used to examine trends in the prevalence of TDR over time.
RESULTS: The observed rate of TDR was higher than true TDR when misclassification was present and increased as the proportion of misclassification increased. As the number of naive patients with a resistance test relative to the number of experienced patients with a test increased, the difference between true and observed TDR decreased. The observed prevalence of TDR in the UK reached a peak of 11.3% in 2002 (odds of TDR increased by 1.10 (95% CI 1.02, 1.19, p(linear trend) = 0.02) per year 1997-2002) before decreasing to 7.0% in 2007 (odds of TDR decreased by 0.90 (95% CI 0.87, 0.94, p(linear trend) <0.001) per year 2002-2007. Trends in adjusted TDR were altered as the misclassification rate increased; the significant downward trend between 2002-2007 was lost when the misclassification increased to over 4%.
CONCLUSION: The effect of misclassification of ART on estimates of the prevalence of TDR may be appreciable, and depends on the number of naive tests relative to the number of experienced tests. Researchers can examine the effect of ART misclassification on their estimates of the prevalence of TDR if such a bias is suspected.
Am J Public Health. 2012 Mar 15. [Epub ahead of print]
Quality of Life of People With HIV/AIDS Receiving Antiretroviral Therapy in Cuba: A Cross-Sectional Study of the National Population.
Aragonés-López C, Pérez-Ávila J, Smith Fawzi MC, Castro A.
Department of Biostatistics and Informatics, Institute of Tropical Medicine, Havana, Cuba; General Direction of the Institute of Tropical Medicine, Havana; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA.
Objectives. We studied the effect of antiretroviral therapy (ART) on the quality of life (QOL) of Cubans with HIV/AIDS.
Methods. We conducted a cross-sectional study including administration of the Medical Outcomes Study-HIV Health Survey Questionnaire to a representative sample of the 1592 Cubans receiving ART in 2004. For univariate analyses, we compared mean HIV scale scores. We used logistic regression models to estimate the association between role function and year of diagnosis, between pain and sex, and between health transition and region of diagnosis, with adjustment for demographics, ART regimen, and clinical status.
Results. There were 354 participants (73 women, 281 men). Scores for all functional activities showed means higher than 80 out of 100. Pain interfered more in women than in men (73.2 vs 81.9; P = .01). When HIV diagnosis occurred after 2001, the probability of experiencing difficulties performing work (odds ratio [OR] = 4.42; 95% CI = 1.83, 10.73) and pain (OR = 1.70; 95% CI = 1.01, 2.88) increased compared with earlier diagnosis. People treated with indinavir showed a greater perception of general health (58.9 vs 52.4; P = .045) and greater health improvement (78.6 vs 67.8; P = .002).
Conclusions. Although Cubans receiving ART are maintaining a high QOL, we observed significant differences by sex and time of diagnosis. QOL assessment can serve as a health outcome and may allow identification of QOL reductions potentially related to ART side effects.
Pharmacoepidemiol Drug Saf. 2011 Dec;20(12):1246-52.
Palatability, adherence and prescribing patterns of antiretroviral drugs for children with human immunodeficiency virus infection in Canada.
Lin D, Seabrook JA, Matsui DM, King SM, Rieder MJ, Finkelstein Y.
Division of Emergency Medicine, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
PURPOSE: To assess the impact of perceived palatability of antiretroviral drugs on adherence to therapy of children infected by human immunodeficiency virus and on prescribing patterns by their caring physicians.
METHODS: Design: Two arms–retrospective chart review and a cross-sectional survey. Setting: Tertiary-care pediatric human immunodeficiency virus clinic during a 17-year period. Participants: Children with human immunodeficiency virus infection and physicians actively caring for children with human immunodeficiency virus infection in seven provinces in Canada were surveyed regarding their perception of the palatability of 8-liquid and 15 non-liquid antiretroviral medications and its effect on drug selection. Main Outcome Measure: Effect of taste preferences of antiretroviral drugs on adherence to treatment by infected children and on drug selection by their caring physicians.
RESULTS: Forty of 119 children (34%) refused at least once to an antiretroviral medication. In 5%, treatment was discontinued because of poor palatability. Ritonavir was the least palatable drug (50% of children; p = 0.01). Ritonavir use (OR 4.80 [95%CI 1.34-17.20]) and male gender (OR 7.25 [95%CI 2.30-22.90]) were independent predictors of drug discontinuation because of poor taste. Physicians also perceived liquid ritonavir as the least palatable (p = 0.01) and the most likely to be discontinued (p = 0.01). However, they commonly prescribed it as first-line therapy (p = 0.06).
CONCLUSIONS: A third of children infected with human immunodeficiency virus fail to adhere to their treatment because of poor drug taste. Physicians are aware of that, but this does not prevent them from selecting the least palatable drugs as first-line therapy.
Curr Clin Pharmacol. 2012 Mar 20. [Epub ahead of print]
Khalili H, Rohani R, Seyedalinaghi S, Hajiabdolbaghi M, Dashti-Khavidaki S, Talasaz AH.
Department of Clinical Pharmacy, Faculty of pharmacy, Tehran University of Medical Sciences, Tehran, Iran. email@example.com
Purpose: Treatment adherence of 95% or higher is recommended for appropriate therapeutic response and improving the function of immune system in HIV positive patients. To the best of our knowledge, there was report of adherence to HAART regimen from Iran. In the present study, we have reported the HAART adherence rate of Iranian HIV positive patients. Method: In a twelve-month period, all patients older than 18 years old who referred to HIV clinic were on HAART regimen enrolled in the study. Beside demographic and clinical characteristics of Iranian HIV positive patients, Adherence to HAART was assessed by self-report and pill count methods at during the three consecutive months of the patients’ visits. Results: The mean of patients’ adherence to HAART regimen based on the self-report method was 69.4%, 64.6% and 62.8% in the first, second and third month of follow up, respectively. The mean of adherence rates in three months follow-up assessed by self-report (65.5%) and pill count (60.4%) methods were correlated significantly (r=0.93 and p<0.001). Living with family members, changing the HAART regimen and stage of disease had a significant relationship with adherence rates. Conclusion: Although the adherence level of Iranian HIV infected patients is acceptable compared to other countries, the available antiretroviral medications are limited in our country, therefore, encouraging patients to have higher levels of adherence is more important.
Int J Equity Health. 2012 Jan 23;11 Suppl 1:A1. [Epub ahead of print]
Department of Public Health & Epidemiology, Pontificia Universidad Javeriana Cali, Cali, Colombia. firstname.lastname@example.org.
There is a paucity of studies on the social determinants of adherence to antiretroviral therapy, especially in Latin American countries. The purpose of the study was twofold: to assess the relationship between antiretroviral adherence and social position among Colombian women with HIV/AIDS and to examine the possibility of expanding the medical concept of adherence to treatment including a “social determinants of health” perspective.
Soc Sci Med. Volume 74, Issue 8, April 2012, p. 1240–1250
Neighborhood drug markets: A risk environment for bacterial sexually transmitted infections among urban youth.
Jennings JM, Taylor RB, Salhi RA, Furr-Holden CD, Ellen JM.
Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD,
We hypothesized that neighborhoods with drug markets, as compared to those without, have a greater concentration of infected sex partners, i.e. core transmitters, and that in these areas, there is an increased risk environment for STIs. This study determined if neighborhood drug markets were associated with a high-risk sex partnership and, separately, with a current bacterial STI (chlamydia and/or gonorrhea) after controlling for individual demographic and sexual risk factors among a household sample of young people in Baltimore City, MD. Analyses also tested whether links were independent of neighborhood socioeconomic status. Data for this study were collected from a household study, systematic social observations and police arrest, public health STI surveillance and U.S. census data. Nonlinear multilevel models showed that living in neighborhoods with household survey-reported drug markets increased the likelihood of having a high-risk sex partnership after controlling for individual-level demographic factors and illicit drug use and neighborhood socioeconomic status. Further, living in neighborhoods with survey-reported drug markets increased the likelihood of having a current bacterial STI after controlling for individual-level demographic and sexual risk factors and neighborhood socioeconomic status. The results suggest that local conditions in neighborhoods with drug markets may play an important role in setting-up risk environments for high-risk sex partnerships and bacterial STIs. Patterns observed appeared dependent on the type of drug market indicator used. Future studies should explore how conditions in areas with local drug markets may alter sexual networks structures and whether specific types of drug markets are particularly important in determining STI risk.
Soc Sci Med. Volume 74, Issue 8, April 2012, p. 1251-1260
Gowan T, Whetstone S, Andic T.
Sociology, University of Minnesota, 909 Social Sciences, 267 19th Ave S, Minneapolis, MN
Our 2007-2009 ethnography describes and analyses the practice of harm reduction in a heroin users’ group in the midwestern United States. While dominant addiction interventions conceptualize the addict as powerless – either through moral or physical weakness – this group contested such “commonsense,” treating illicit drug use as one of many ways that modern individuals attempt to “fill the void.” Insisting on the destigmatization of addiction and the normalization of illicit drug use, the group helped its members work on incremental steps toward self-management. Although “Connection Points” had very limited resources to improve the lives of its members, our work suggests that the users’ group did much to restore self-respect, rational subjectivity, and autonomy to a group historically represented as incapable of reason and self-control. As the users cohered as a community, they developed a critique of the oppressions suffered by “junkies,” discussed their rights and entitlements, and even planned the occasional political action. Engaging with literature on the cultural construction of agency and responsibility, we consider, but ultimately complicate, the conceptualization of needle exchange as a “neoliberal” form of population management. Within the context of the United States’ War on Drugs, the group’s work on destigmatization, health education, and the practice of incremental control showed the potential for reassertions of social citizenship within highly marginal spaces.
Free alcohol theme journal issue, J Psychopharmacol February 2012. for a limit time, click on PDF links
Prevention Science, 2012, Volume 13, Number 2, 118-128,
Alison Hipwell, Stephanie Stepp, Tammy Chung, Vanessa Durand & Kate Keenan
Abstract/1st page image http://www.springerlink.com/content/y516733374812038/
Adolescent sexual risk-taking is common and often occurs under the influence of alcohol. Although alcohol use emerges in early adolescence, there is little empirical research examining whether growth in alcohol use during this developmental period predicts later risky sexual behavior. Such information could provide a critical opportunity for the prevention of sexually transmitted infections and unwanted teenage pregnancies. The current study examined alcohol use as a developmental mediator of the relationship between conduct problems, impulsivity, poverty, race and menarche assessed at age 11, and sexual risk-taking among girls at age 16. The sample comprised 499 participants of the Pittsburgh Girls Study (57.7% African American and 42.3% European American) interviewed annually for 6 years between age 11 and 16. The results of the conditioned latent growth curve model showed that the rate of increase in alcohol use, and African American race, predicted higher rates of sexual risk-taking at age 16. However, European American race predicted the intercept and slope of alcohol use. When mediation was tested, the results showed that age 12 use and an increase in propensity for alcohol use between 12 and 15 explained the relationship between European American race and later risky sex, but this was not the case for African American girls. Use of alcohol at age 12 also mediated the association between early menarche and subsequent sexual risk-taking. The implications of the findings for sexual risk prevention are discussed.
Int J Drug Policy. 2012 Mar 13. [Epub ahead of print]
Bridge J, Hunter BM, Atun R, Lazarus JV.
The Global Fund to Fight AIDS, Tuberculosis and Malaria, Chemin de Blandonnet 8, 1214 Vernier, Geneva, Switzerland.
BACKGROUND: Injecting drug use has been documented in 158 countries and is a major contributor to HIV epidemics. People who inject drugs have poor and inequitable access to HIV services. The Global Fund to Fight AIDS, Tuberculosis and Malaria is the leading multilateral donor for HIV programmes and encourages applicants to include harm reduction interventions in their proposals. This study is the first detailed analysis of Global Fund investments in harm reduction interventions.
METHODS: The full list of more than 1000 Global Fund grants was analysed to identify HIV grants that contain activities for people who inject drugs. Data were collected from the detailed budgets agreed between the Global Fund and grant recipients. Relevant budget lines were recorded and analysed in terms of the resources allocated to different interventions.
RESULTS: 120 grants from 55 countries and territories contained activities for people who inject drugs worth a total of US$ 361million, increasing to US$ 430million after projections were made for grants that had yet to enter their final phase of funding. Two-thirds of the budgeted US$ 361million was allocated to core harm reduction activities as defined by the United Nations. Thirty-nine of the 55 countries were in Eastern Europe and Asia. Only three countries with generalised HIV epidemics had grants that included harm reduction activities.
CONCLUSION: This study represents the most comprehensive assessment of Global Fund investments in harm reduction. This funding, while substantial, falls short of the estimated needs. Investments in harm reduction must increase if HIV transmission among people who inject drugs is to be halved by 2015.
Ann Epidemiol. 2012 Mar 14. [Epub ahead of print]
Evaluating Consistency in Repeat Surveys of Injection Drug Users Recruited by Respondent-Driven Sampling in the Seattle Area: Results from the NHBS-IDU1 and NHBS-IDU2 Surveys.
Burt RD, Thiede H.
HIV/AIDS Epidemiology Program, Public Health-Seattle & King County, Seattle, WA.
PURPOSE: We compared data from two respondent-driven sampling (RDS) surveys of Seattle-area injection drug users (IDU) to evaluate consistency in repeat RDS surveys.
METHODS: The RDS-adjusted estimates for 16 key sociodemographic, drug-related, sexual behavior, and HIV- and hepatitis C virus-related variables were compared in the 2005 and the 2009 National HIV Behavioral Surveillance system surveys (NHBS-IDU1 and NHBS-IDU2). Time trends that might influence the comparisons were assessed by the use of data from reported HIV cases in IDU, surveys of needle exchange users, and two previous IDU studies.
RESULTS: NHBS-IDU2 participants were more likely than NHBS-IDU1 participants to report older age, heroin as their primary injection drug, male-to-male sex, unprotected sex with a partner of nonconcordant HIV status, and to self-report HIV-positive status. NHBS-IDU2 participants were less likely to report residence in downtown Seattle, amphetamine injection, and a recent HIV test. Time trends among Seattle-area IDU in age, male-to-male sex, and HIV testing could have influenced these differences.
CONCLUSIONS: The number and magnitude of the estimated differences between the two RDS surveys appeared to describe materially different populations. This could be a result of changes in the characteristics of Seattle-area IDU over time, of accessing differing subpopulations of Seattle IDU, or of high variability in RDS measurements.
Muscle Nerve. 2012 Apr;45(4):471-476.
Robinson-Papp J, Gelman BB, Grant I, Singer E, Gensler G, Morgello S; for the National NeuroAIDS Tissue Consortium.
Department of Neurology, Mount Sinai School of Medicine, New York. email@example.com.
Introduction: Human immunodeficiency virus (HIV)-infected patients commonly develop distal symmetric polyneuropathy (DSP). Age, ethnicity, and toxic exposures may influence the risk. In this study we examined the association between substance use, antiretrovirals, ethnicity, and incident neuropathy in an HIV-infected cohort.
Methods: Data were obtained from the National NeuroAIDS Tissue Consortium (NNTC), an ongoing, prospective cohort started in 1998. Cox proportional hazards models were used to examine the association of substance use, demographics, neurotoxic antiretrovirals, and laboratory parameters with incident neuropathy in 636 participants who were neuropathy-free at baseline.
Results: The cumulative incidence of DSP was 41%. Substance use (P = 0.04), number of substances used (P = 0.04), and longer duration of HIV infection (P = 0.05) were associated with incident DSP, but demographic factors, use of neurotoxic antiretrovirals, and laboratory parameters were not.
Conclusions: Substance use and longer duration of HIV infection are risk factors for DSP in HIV-infected patients. Use of multiple substances may be particularly risky. Muscle Nerve, 2012.
Ir J Med Sci. 2012 Mar 20. [Epub ahead of print]
The natural history of injecting drug use: a 25-year longitudinal study of a cohort of injecting drug users in inner city Dublin.
O’Kelly FD, O’Kelly CM.
Department of Primary Care and Public Health, Trinity College Dublin, Dublin, Ireland, firstname.lastname@example.org.
BACKGROUND: Injecting drug use is associated with increased morbidity and mortality. This is the first longitudinal study of a community-based population of injecting drug users (IDUs) in the Republic of Ireland.
AIM: To establish the natural history of IDUs in a deprived Dublin community.
METHODS: Eighty-two IDUs (heroin) were recruited over the summer months of 1985. The prevalence of drug use in this district electoral area was established in 1985 and followed-up over a 25-year period with two formal interviews in 1995 and 2010.
RESULTS: It is a descriptive study of a cohort of IDUs established in 1985 prior to human immunodeficiency virus (HIV) testing being available. The majority of the cohort recruited included single, unemployed males aged 20 to 29 years, who had served a prison sentence. Fifty-one (63 %) of the cohort had died by 2010, of which 26 were attributed to HIV disease. The mean age of death was 35.9 years of age (standard deviation 4.1 years). Fifty-two (63 %) of the cohort tested positive for HIV and 58 (71 %) for hepatitis B between 1985 and 2010. The median survival time for those with a positive HIV status was 17 years (95 % CI 14.0-20.0) and for those with a positive hepatitis C status, 21 years (95 % CI 15.5-26.5).
CONCLUSIONS: The lifestyle of IDUs, as demonstrated by the experience of this cohort, has hazardous consequences resulting in high levels of morbidity and mortality. A relatively stable picture of HIV associated with IDUs is now emerging in Ireland, as is the case throughout most of the EU. HIV is a more manageable chronic disease, posing challenges for primary care in its treatment of former and existing IDUs who are ageing and now have other chronic diseases.
AIDS Patient Care STDS. 2012 Mar 19. [Epub ahead of print]
Young Age Predicts Poor Antiretroviral Adherence and Viral Load Suppression Among Injection Drug Users.
Hadland SE, Milloy MJ, Kerr T, Zhang R, Guillemi S, Hogg RS, Montaner JS, Wood E.
Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
Previous studies of adherence to antiretroviral therapy (ART) for HIV among young injection drug users (IDU) have been limited because financial barriers to care disproportionately affect youth, thus confounding results. This study examines adherence among IDU in a unique setting where all medical care is provided free-of-charge. From May 1996 to April 2008, we followed a prospective cohort of 545 HIV-positive IDU of 18 years of age or older in Vancouver, Canada. Using generalized estimating equations (GEE), we studied the association between age and adherence (obtaining ART≥95% of the prescribed time), controlling for potential confounders. Using Cox proportional hazards regression, we also studied the effect of age on time to viral load suppression (<500 copies per milliliter), and examined adherence as a mediating variable. Five hundred forty-five participants were followed for a median of 23.8 months (interquartile range [IQR]=8.5-91.6 months). Odds of adherence were significantly lower among younger IDU (adjusted odds ratio [AOR]=0.76 per 10 years younger; 95% confidence interval [CI], 0.65-0.89). Younger IDU were also less likely to achieve viral load suppression (adjusted hazard ratio [AHR]=0.75 per 10 years younger; 95% CI, 0.64-0.88). Adding adherence to the model eliminated this association with age, supporting the role of adherence as a mediating variable. Despite absence of financial barriers, younger IDU remain less likely to adhere to ART, resulting in inferior viral load suppression. Interventions should carefully address the unique needs of young HIV-positive IDU.
Int J Drug Policy. 2012 Mar 12. [Epub ahead of print]
The Graduate Center, The City University of New York, Doctoral Program in Sociology, New York; National Development and Research Institutes, Inc., Behavioral Sciences Training Program, New York.
This paper explores the position of needle exchange programmes (NEPs) in the “geography of survival” in the South Bronx neighbourhood of New York City. Stemming the spread of HIV through the provision of sterile injecting equipment, needle exchange promotes the survival of injection drug users (IDUs) in the starkest sense; yet NEPs also attract a diverse population of service users whose attendance is not necessarily related to drugs. This paper locates NEPs among a larger constellation of social services accessed by residents of poor neighbourhoods, including injection drug users, the homeless, the hungry, and those in need of medical services or just safe space. Drawing on ethnographic and interview data from a needle exchange in the South Bronx, I describe how both IDUs and others employed the organisation to make ends meet, elaborating four “off-label” usages of needle exchange: as a place to obtain basic necessities, as a source of income, as a safe space, and as a site of social contact. As harm reduction in the United States moves towards an increasingly clinical model of care, this paper considers these latent functions of needle exchange within the context of a larger struggle over the content and meaning of harm reduction services. By themselves, NEPs are clearly an unsatisfactory solution to the economic and political circumstances that drive a variety of individuals through their doors; yet, in a country that lacks a comprehensive welfare system, needle exchange arguably represents an important thread within a social safety net that is being woven from the ground up. This study may be used to argue for a (re)expanded mission for harm reduction in the United States, in the face of constant moves to narrow its mandate and reduce its budget.
J Correct Health Care. 2012 Mar 14. [Epub ahead of print]
Seal DW, Parisot M, Difranceisco W.
Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI.
Men’s risk behavior during a 3-month period prior to parole revocation was assessed. Frequent alcohol use was higher among men who had more children, were homeless, or had a history of alcohol and other drug abuse treatment. The use of drugs was greater among men who were younger or had a history of sexually transmitted infection (STI). The use of hard drugs was higher among men who had history of injection drug use. Unprotected vaginal or anal sex was increased among men who were younger, single, or had a history of STIs. Sex with a high-risk partner was greater among men who were older, used hard drugs, or had a history of STIs. Findings highlight the importance of developing risk-reduction programs for men on parole.
J Sex Res. 2012 Mar 16. [Epub ahead of print]
The Use of Drinking and Condom-Related Protective Strategies in Association with Condom Use and Sex-Related Alcohol Use.
Gilmore AK, Granato HF, Lewis MA.
Department of Psychology, University of Washington.
Approximately 40% of American college students engage in heavy drinking, and heavy drinking is associated with sexual risk behaviors. It is imperative to gain a better understanding of the relationship between alcohol and sexual risk behaviors for prevention efforts. This article examined the use of drinking and condom-related protective behavioral strategies (PBS) in relation to drinking and condom-use outcomes in 436 college students. Drinking PBS are related to drinking and negative alcohol-related consequences. Furthermore, condom-related PBS are related to condom use; however, it is unclear if drinking PBS are related to condom use, particularly condom use when drinking. It was hypothesized that the use of drinking PBS would be related to less alcohol-related sexual activity, that the use of condom-related PBS would be related to greater condom use and condom use while drinking, and that drinking PBS would be related to greater condom use, especially condom use when drinking. It was found that condom-related PBS were associated with condom behavior and drinking PBS were related to drinking behavior, but we did not find support for a relationship between drinking PBS and condom use. This suggests that condom-related PBS may be a more effective target for increasing condom use than drinking PBS alone.
J Sex Res. 2012 Mar 21. [Epub ahead of print]
Sonya G. Arreola, George Ayala, Rafael M. Díaz & Alex H. Kral
Urban Health Program, RTI International.
There is a high prevalence of childhood sexual abuse and HIV among Latino gay men, with limited proven HIV prevention interventions. This study used qualitative methods to explicate earlier findings showing differential health outcomes among Latino gay men who had no sex, voluntary, or forced sex before age 16. Analyses of in-depth interviews with 27 Latino gay men revealed that structural factors in childhood contribute to their developing sexuality by enhancing or inhibiting a sense of agency. Agency is essential for making decisions that are in line with their intentions to have healthy sexual lives. Findings suggest that interventions should focus on developing a sense of sexual agency among Latino gay men by (a) increasing their recognition of structural factors that contribute to feelings of worthlessness in order to relocate internalized blame and homophobia to external structural forces, (b) facilitating awareness of the social structural oppressions that lead to psychological and sexual risk in order to enhance their options for sexual health, and (c) shifting from individually focused constructions of sexual health to those that consider the structural factors that reduce agency and contribute to diminished sexual health among Latino gay men.
AIDS Behav. 2012 Mar 20. [Epub ahead of print]
“It’s Hard to Know What is a Risky or not a Risky Decision”: Gay Men’s Beliefs About Risk During Sex.
Prestage G, Brown G, Down IA, Jin F, Hurley M.
Kirby Institute, University of New South Wales, Darlinghurst, Sydney, Australia, email@example.com.
Abstract/1st page image: http://www.springerlink.com/content/t7850n39l038n858/
Gay men increasingly use non condom-based risk reduction strategies to reduce the possibility of HIV transmission. Such strategies rely on men’s knowledge and communication with each other, but how they employ these strategies may depend as much on their attitudes toward risk and pleasure. We explored current beliefs about safe sex, sexual desire and risk behavior in an online survey of 2306 Australian gay men. The survey included free text components to explore men’s beliefs about risk and pleasure. We conducted a principal components factor analysis on the safe sex belief items in the survey, and thematic analysis of the qualitative material was used to interrogate the concepts underpinning these beliefs. We identified two measures of safe sex beliefs: risk reduction optimism (HRRO; α = 0.703); and viral load optimism (α = 0.674). In multivariate analysis, unprotected anal intercourse with casual partners (UAIC) was associated with HRRO among non HIV-positive men only (p < 0.001), but, regardless of HIV serostatus, UAIC was associated with a belief that serosorting could be an effective risk reduction strategy and with being more sexually adventurous in general. Using the qualitative data we identified four themes in how men think about HIV: ‘seeking certainty’, ‘regretful actions’, ‘nothing is safe’, and ‘acting on beliefs’. Each theme interacted with the safe sex beliefs measures to provide a highly contextualised understanding of men’s beliefs about safe in specific circumstances. Gay men think about the risk of HIV transmission in qualitatively different ways depending on specific circumstances. While measures of belief about relative risk of HIV transmission are useful indicators of men’s propensity to take risk, they oversimplify men’s thinking about risk, and fail to account for the role of desire, both in influencing men’s thinking about risk, and in how they balance their perception of relative risk against the pursuit of pleasure.
HIV Med. 2012 Mar 21. doi: 10.1111/j.1468-1293.2012.01011.x. [Epub ahead of print]
Improved strategies for HIV diagnosis among men who have sex with men (MSM) in Buenos Aires, Argentina, a population with a high prevalence and incidence of HIV infection.
Pando M, Coloccini R, Schvachsa N, Pippo M, Alfie L, Marone R, Gomez-Carrillo M, Avila M, Salomón H.
Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, Buenos Aires, Argentina.
BACKGROUND: In Argentina, HIV diagnosis in adults is made using one or two enzyme immunoassay tests and a confirmatory test. These strategies may fail to identify infected individuals during early primary infection, which represents an important public health problem among groups with a high HIV incidence, such as men who have sex with men (MSM) (6.3% persons/year). The general objective of this study was to contribute to reducing HIV transmission among MSM through the identification of antibody-negative, nucleic acid-positive individuals.
FINDINGS: A total of 1549 MSM were recruited for an HIV seroprevalence study. A total of 161 (10.4%) MSM were HIV-positive and 14 (0.9%) were indeterminate. Among the 1374 negative individuals, 16 (1.2%) exhibited reactive results in the screening assay. Indeterminate Western blot (WB) samples and negative WB samples (with discordant results in the screening) were analysed to detect HIV nucleic acid by viral load testing. Up to 23.1% of HIV-indeterminate WB samples and 7.1% of HIV-negative WB samples with discordant results in the screening assays had detectable nucleic acid. Overall, 14.8% of the samples with discordant or indeterminate results were identified as HIV-positive using direct diagnosis. With the identification of four new cases using the nucleic acid detection test, the HIV prevalence in MSM increased by 0.3% (from 10.4 to 10.7%).
CONCLUSIONS: The results of this study suggest the importance of including nucleic acid detection in the HIV algorithm for MSM with HIV-indeterminate WB results and those with HIV-negative WB results and discordant results in screening assays, in order to decrease HIV transmission among this population with a high HIV prevalence and incidence.
HIV Med. 2012 Mar 21. doi: 10.1111/j.1468-1293.2012.01005.x. [Epub ahead of print]
Substance use and sexual risk behaviour among HIV-positive men who have sex with men in specialized out-patient clinics.
Dirks H, Esser S, Borgmann R, Wolter M, Fischer E, Potthoff A, Jablonka R, Schadendorf D, Brockmeyer N, Scherbaum N.
Addiction Research Group at the Department of Psychiatry and Psychotherapy, LVR-Klinikum Essen, Hospital of the University of Duisburg-Essen, Essen, Germany.
OBJECTIVES: Unprotected sexual intercourse between men who have sex with men (MSM) is the most common route of HIV infection in Germany. Approximately 70% of newly infected people are MSM. Substance use is a determinant of sexual risk behaviour in the general population, but also in the MSM subpopulation. There are only a few studies, from the USA, on the correlation between substance use and sexual risk behaviour in HIV-infected MSM in specialized care.
METHODS: In a German sample of 445 HIV-infected MSM treated in specialized out-patient clinics, the influence of substance use on sexual risk behaviour was investigated. Information was obtained from subjects using self-report questionnaires and a structured interview.
RESULTS: Recreational drug use was common. The prevalences of cannabis addiction (4.5%), harmful use of cannabis (4.3%) and harmful use of dissociative anaesthetics (0.4%) were higher than in the general German male population. A substantial proportion of patients reported unprotected insertive (32.9%) and receptive (34.6%) anal intercourse during the last 12 months. Use of cannabis, amyl nitrite, dissociative anaesthetics, cocaine, amphetamines and erectile dysfunction medication was significantly correlated with unprotected sexual contacts. Substance use in the context of sexual activity significantly increased sexual risk behaviour.
CONCLUSIONS: Substance use, especially in the context of sexual activity, should be taken into account when developing new prevention and intervention programmes aimed at reducing sexual risk behaviour in HIV-infected MSM currently in specialized care.
Sex Transm Infect. 2012 Mar 21. [Epub ahead of print]
Access to and use of unauthorised online HIV self-tests by internet-using French-speaking men who have sex with men.
Greacen T, Friboulet D, Fugon L, Hefez S, Lorente N, Spire B.
Laboratoire de recherche, EPS Maison Blanche, Paris, France.
ObjectivesAlthough not authorised in France, HIV self-tests are easily available online. The authors questioned French-speaking internet-using men who have sex with men (MSM) concerning their access to and use of such tests.MethodsOnline questionnaire on sex websites and gay and HIV community websites. A multivariate logistic regression for rare events was used to identify factors associated with accessing self-tests.Results9169 MSM completed the questionnaire. 2748 (30%) were aware of online self-tests, but only 82 of those aware and not already HIV positive (3.5%) declared having accessed one and only 69 using it. In the multivariate model, living one’s sex-life with men in absolute secrecy (odds ratio (OR)=3.90, 95% CI 1.73 to 8.76), knowing of the tests via a sex partner (OR=3.42, CI 1.39 to 8.41) or an internet search engine (OR=2.18, CI 1.26 to 3.74) but not through the general (OR=0.21, CI 0.11 to 0.42) or the gay press (OR=0.34, CI 0.16 to 0.73), having unprotected anal intercourse with a casual partner in the preceding year (OR=1.90, CI 1.17 to 3.06), using self-tests for other diseases (OR=2.66, CI 1.43 to 4.90), using poppers (OR=2.23, CI 1.35 to 3.67) and doping products (OR=3.53, CI 1.55 to in the preceding year, having done a traditional HIV test but not in the preceding year (OR=1.93, CI 1.14 to 3.32), never having had suicidal thoughts (OR=0.54, CI 0.32 to 0.90) and living in the provinces (OR=1.80, CI 1.01 to 3.25) were all independently associated with accessing self-tests.ConclusionsAlthough readiness to admit use of unauthorised medical products may have influenced results, few MSM aware of the existence of self-tests actually declared having accessed one. Accessing the self-test was independently associated with both living one’s sex-life with men in total secrecy and having had unprotected anal intercourse in the last 12 months, indicating that autonomous self-testing may reduce barriers to testing for this vulnerable population.
Infect Genet Evol. 2012 Mar 10. [Epub ahead of print]
Molecular typing of the recently expanding subtype B HIV-1 epidemic in Romania: Evidence for local spread among MSMs in Bucharest area.
Paraschiv S, Otelea D, Batan I, Baicus C, Magiorkinis G, Paraskevis D.
Molecular Diagnostics Laboratory, ‘Prof. Dr. Matei Bals’ National Institute for Infectious Diseases, Str. Calistrat Grozovici, Bucharest, Romania.
HIV-1 subtype B is predominant in Europe except in some countries from Eastern Europe which are characterized by a high prevalence of non-B subtypes and circulating recombinant forms (CRFs). Romania is a particular case: the HIV-1 epidemic started with subtype F1 which is still the most prevalent. Previous studies have shown an increasing prevalence of subtype B which is the second most frequent one among the newly diagnosed individuals, followed by subtype C and several CRFs as well as unique recombinant forms (URFs). Our objective was to analyze in detail the characteristics (way of dispersal, association with transmission risk groups) of the subtype B infections in Romania by means of phylogenetic analysis. Among all the individuals sampled during 2003-2010, 71 out of 1127 patients (6.3%) have been identified to be infected with subtype B strains. The most frequent route of infection identified in HIV-1 subtype B patients in Romania was MSM transmission (39.6%), followed by the heterosexual route (35.2%). Many of the patients acquired the infection abroad, mainly in Western European countries. Phylogenetic analysis indicated the existence of a local transmission network (monophyletic clade) including 14 patients, mainly MSM living in the Bucharest area. We estimate the origin of the local transmission network that dates at the beginning of the 90s; the introduction of the F1 and C subtypes occurred earlier. The rest of the sequences were intermixed with reference strains sampled across Europe suggesting that single infection were not followed by subsequent dispersal within the local population. Although HIV-1 subtype B epidemic in Romania is recent, there is evidence for local spread among the MSMs, in addition to multiple introductions.
J Acquir Immune Defic Syndr. 2012 Mar 14. [Epub ahead of print]
Sexual risk behaviors, circumcision status and pre-existing immunity to adenovirus type 5 among men who have sex with men participating in a randomized HIV-1 vaccine efficacy trial: Step Study.
Koblin BA, Mayer KH, Noonan E, Wang CY, Marmor M, Sanchez J, Brown SJ, Robertson MN, Buchbinder SP.
New York Blood Center, New York; Fenway Health, Boston, MA; Fred Hutchinson Cancer Research Center, Seattle, WA; New York University School of Medicine, New York…
BACKGROUND: The Step Study found that men who had sex with men (MSM) who received an adenovirus type 5 (Ad5) vector-based vaccine and were uncircumcised or had prior Ad5 immunity had a higher HIV incidence than MSM who received placebo. We investigated whether differences in HIV exposure, measured by reported sexual risk behaviors, may explain the increased risk.
METHODS: Among 1,764 MSM in the trial, 724 were uncircumcised, 994 had prior Ad5 immunity and 560 were both uncircumcised and had prior Ad5 immunity. Analyses compared sexual risk behaviors and perceived treatment assignment among vaccine and placebo recipients, determined risk factors for HIV acquisition and examined the role of insertive anal intercourse in HIV risk among uncircumcised men.
FINDINGS: Few sexual risk behaviors were significantly higher in vaccine vs. placebo recipients at baseline or during follow-up. Among uncircumcised men, vaccine recipients at baseline were more likely to report unprotected insertive anal intercourse with HIV negative partners (25.0% vs. 18.1%; p=0.03). Among uncircumcised men who had prior Ad5 immunity, vaccine recipients were more likely to report unprotected insertive anal intercourse with partners of unknown HIV status (46.0% vs. 37.5%; p=0.05). Vaccine recipients remained at higher risk of HIV infection compared to placebo recipients (HR =2.8; 95% CI:1.7, 6.8) controlling for potential confounders.
INTERPRETATION: These analyses do not support a behavioral explanation for the increased HIV infection rates observed among uncircumcised men in the Step Study. Identifying biologic mechanisms to explain the increased risk is a priority.
AIDS Res Ther. 2012 Mar 19;9(1):9.
Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs.
Sarna A, Luchters S, Pickett M, Chersich M, Okal J, Geibel S, Kingola N, Temmerman M.
BACKGROUND: HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment.
RESULTS: Using modified targeted snowball sampling, 698 PLHIV were recruited through community health workers and HIV-positive peer counsellors. Of the 59.2% sexually-active PLHIV, 24.5% reported multiple sexual partners. Of all sexual partners, 10.2% were HIV negative, while 74.5% were of unknown HIV status. Overall, unprotected sex occurred in 52% of sexual partnerships; notably with 32% of HIV-negative partners and 54% of partners of unknown HIV status in the last 6 months. Multivariate analysis, controlling for intra-client clustering, showed non-disclosure of HIV status (AOR: 2.38, 95%CI: 1.47-3.84, p < 0.001); experiencing moderate levels of perceived stigma (AOR: 2.94, 95%CI: 1.50-5.75, p = 0.002); and believing condoms reduce sexual pleasure (AOR: 2.81, 95%CI: 1.60-4.91, p < 0.001) were independently associated with unsafe sex. Unsafe sex was also higher in those using contraceptive methods other than condoms (AOR: 5.47, 95%CI: 2.57-11.65, p < 0.001); or no method (AOR: 3.99, 95%CI: 2.06-7.75, p < 0.001), compared to condom users.
CONCLUSIONS: High-risk sexual behaviors are common among PLHIV not accessing treatment services, raising the risk of HIV transmission to discordant partners. This population can be identified and reached in the community. Prevention programs need to urgently bring this population into the ambit of prevention and care services. Moreover, beginning HIV treatment earlier might assist in bringing this group into contact with providers and HIV prevention services, and in reducing risk behaviours.
J Eur Acad Dermatol Venereol. 2012 Mar 16. [Epub ahead of print]
Sexual behaviours, knowledge and attitudes regarding safe sex, and prevalence of non-viral sexually transmitted infections among attendees of youth clinics in St. Petersburg, Russia.
Shipitsyna E, Krasnoselskikh T, Zolotoverkhaya E, Savicheva A, Krotin P, Domeika M, Unemo M.
D.O. Ott Research Institute of Obstetrics and Gynaecology, St. Petersburg, Russia; Pavlov State Medical University, St. Petersburg, Russia; City Youth Clinic Yuventa, St. Petersburg, Russia…
Background: Adolescents and young adults are at increased risk of sexually transmitted infections (STIs). Knowledge of STI prevalence and risk factors are essential tools to elaborate preventive strategies. However, internationally reported studies on epidemiology of STIs among the youth in Russia are mainly lacking.
Objectives: To ascertain sexual behaviours, knowledge and attitudes about safe sex and prevalence and correlates with STIs in attendees of youth clinics in St. Petersburg, Russia.
Methods: A total of 301 women and 131 men, who self-referred for STI testing, completed a questionnaire and were screened for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, and Trichomonas vaginalis using nucleic acid amplification tests.
Results: The overall STI prevalence was 16.9%, and similar in the female patients and male patients (15.6% and 19.8% respectively). C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis were detected in 13%, 2.5%, 4.6% and 1.2% of the attendees respectively. The men displayed riskier sexual behaviours and worse knowledge and attitudes regarding safe sex compared to the women, with the most distinguishing features being younger age at first intercourse (P<0.0005), higher numbers of sex partners during lifetime (P=0.001) and latest 6 months (P < 0.0005), more frequently consuming alcohol (P<0.0005), poorer knowledge of STI/HIV prevention measures (P<0.0005), and less positive attitudes towards safe sex (P=0.001). However, no significant predictors of STI positivity were found in the men. In the women, the strongest predictors of STI positivity were young age (15-19 years) and multiple sex partners (≥2) during latest 6 months.
Conclusions: The overall prevalence of STIs among users of STI services at youth clinics in St. Petersburg was high. Comprehensive epidemiological data on STI prevalence and sexual behaviour correlates are necessary to initiate new and strengthen existing STI prevention programmes for the youth, in Russia as well as in many other settings.
AIDS Care. 2012 Mar 20. [Epub ahead of print]
Bonnenfant YT, Hindin MJ, Gillespie D.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore , MD.
This research examines whether members of HIV affected couples are more likely to change their abstinence and condom intentions than members of HIV- couples during couple voluntary counseling and testing (VCT). A total of 1260 couple VCT clients in Ethiopia were asked about their sexual risk behavior intentions for the next two months after pre-test and post-test counseling. Multinomial logistic regression was used to determine whether the couple’s HIV status was associated with changed intentions to abstain or use condoms between pre-test and post-test. Individuals belonging to male HIV+ serodiscordant couples (aRRR = 7.98, p < 0.001), female HIV+ serodiscordant couples (aRRR = 5.85, p < 0.001), and HIV+ concordant couples (aRRR = 3.12, p = 0.05) were more likely to have increased their intentions to abstain or use condoms in the next two months than individuals in HIV- concordant relationships. The couple’s HIV status was not associated with decreased intentions to abstain or use condoms in the next two months. Counseling for all HIV affected couples should include practical information on obtaining and using condoms. This includes HIV affected couples who intend to abstain from sex, whether for a short or long period of time, so that they are prepared to have protected sex if their intentions change.
Subst Use Misuse. 2012 Apr;47(5):522-34.
Mackenzie S, Pearson C, Frye V, Gómez CA, Latka MH, Purcell DW, Knowlton AR, Metsch LR, Tobin KE, Valverde EE, Knight KR.
Health Equity Institute, San Francisco State University, San Francisco, California
This paper presents a qualitative investigation of peer mentoring among HIV seropositive injection drug users in a randomized controlled trial, the INSPIRE study. Qualitative analyses of 68 in-depth open-ended interviews conducted in 2005 in Baltimore, New York, Miami, and San Francisco revealed that these individuals conceptualized themselves as change agents through the identity of peer mentor at the three related domains of individual, interpersonal, and community-level change. Implications for program development and future research of peer mentoring as a mechanism for HIV prevention are discussed.
Subst Use Misuse. 2012 Apr;47(5):502-10.
Collective empowerment while creating knowledge: a description of a community-based participatory research project with drug users in Bangkok, Thailand.
Hayashi K, Fairbairn N, Suwannawong P, Kaplan K, Wood E, Kerr T.
Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada.
In light of growing concerns regarding the ongoing drug war in Thailand and a lack of support for people who inject drugs in this setting, in 2008, we undertook a community-based participatory research project involving a community of active drug users at a peer-run drop-in center in Bangkok. This case study describes a unique research partnership developed between academic and active drug users and demonstrates that participatory approaches can help empower this vulnerable population while generating valid research. Further research is needed to explore ways of optimizing community-based participatory research methods when applied to drug-using populations.
Subst Use Misuse. 2012 Apr;47(5):491-501.
The injection support team: a peer-driven program to address unsafe injecting in a canadian setting.
Small W, Wood E, Tobin D, Rikley J, Lapushinsky D, Kerr T.
British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada.
In 2005, members of the Vancouver Area Network of Drug Users (VANDU) formed the Injection Support Team (IST). A community-based research project examined this drug-user-led intervention through observation of team activities, over 30 interviews with team members, and 9 interviews with people reached by the team. The IST is composed of recognized “hit doctors,” who perform outreach in the open drug scene to provide safer injecting education and instruction regarding safer assisted-injection. The IST represents a unique drug-user-led response to the gaps in local harm reduction efforts including programmatic barriers to attending the local supervised injection facility.
AIDS Care. 2012 Mar 20. [Epub ahead of print]
HealthCall: technology-based extension of motivational interviewing to reduce non-injection drug use in HIV primary care patients – a pilot study.
Aharonovich E, Greenstein E, O’Leary A, Johnston B, Seol SG, Hasin DS.
Department of Psychiatry, Columbia University, New York, NY.
To reduce non-injection drug use (NIDU) among HIV primary care patients, more than a single brief intervention may be needed, but clinic resources are often too limited for extended interventions. To extend brief motivational interviewing (MI) to reduce NIDU, we designed and conducted a pilot study of “HealthCall,” consisting of brief (1-3 minutes) daily patient calls reporting NIDU and health behaviors to a telephone-based interactive voice response (IVR) system, which provided data for subsequent personalized feedback. Urban HIV adult clinic patients reporting ≥4 days of NIDU in the previous month were randomized to two groups: MI-only (n=20) and MI+HealthCall (n=20). At 30 and 60 days, patients were assessed and briefly discussed their NIDU behaviors with their counselors. The outcome was the number of days patients used their primary drug in the prior 30 days. Medical marijuana issues precluded HealthCall with patients whose primary substance was marijuana (n=7); excluding these, 33 remained, of whom 28 patients (MI-only n=17; MI+HealthCall n=11) provided post-treatment data for analysis. Time significantly predicted reduction in “days used” in both groups (p<0.0001). At 60 days, between-group differences approached trend level, with an effect size of 0.62 favoring the MI+HealthCall arm. This pilot study suggests that HealthCall is feasible and acceptable to patients in resource-limited HIV primary care settings and can extend patient involvement in brief intervention with little additional staff time. A larger efficacy trial of HealthCall for NIDU-reduction in such settings is warranted.
J Sex Med. 2012 Mar 16. [Epub ahead of print]
Young Women’s Perceived Health and Lifetime Sexual Experience: Results from the National Survey of Family Growth.
Hall KS, Moreau C, Trussell J.
Princeton University, Princeton, NJ; Inserm, France; The Hull York Medical School, Hull, England.
Introduction. Sexuality is a component of health and well-being for all women, including adolescents. Yet relationships between young women’s health perceptions and sexual behavior are unclear.
Aim. We examined associations between perceived health and lifetime sexual experiences among young U.S. women.
Methods. We used data from 4,413 young women ages 15-24 years in the National Survey of Family Growth, 2002-2008. Descriptive, bivariate, and multivariate statistics estimated relationships between categories of perceived health and types of lifetime sexual experience.
Main Outcome Measures: A self-rated health Likert item and sexual history questions were administered with a computer-assisted survey instrument.
Results: Young women reported excellent (30%), very good (41%), good (23%), and fair-poor (6%) health. Sexual experiences included vaginal (64%), oral (64%), and anal (20%) sex. Negative experiences included involuntary sex (11%) and sexually transmitted infection (STI) history (8%). In multivariate logistic regression models, lower perceived health (“good” rather than “excellent”) was positively associated with vaginal (odds ratio [OR] 1.5, confidence interval [CI] 1.1-2.1, P=0.02), oral (OR 1.5, CI 1.1-2.1, P=0.005), and anal (OR 1.4, CI 1.0-2.0, P=0.03) sex. In models stratified by age, point estimates for vaginal (OR 1.8, CI 1.2-2.6, P=0.002) and oral (OR 1.9, CI 1.4-2.6, P<0.001) sex were higher among adolescents ages 15-19 years, but associations were insignificant among young adults ages 20-24 years. When controlling for negative sexual experiences, point estimates were stable in models including STI history but statistically insignificant when including involuntary sexual experience. Other characteristics associated with sexual experiences varied by type of experience and included age, race/ethnicity, employment situation, poverty level, insurance status, childhood family situation, religious service participation, cohabitation/marital experience, and body mass index.
Conclusions. Further investigation is warranted to disentangle potentially negative relationships between perceived health (as well as response bias and more objective health outcomes), sociodemographic factors, and diverse sexual experiences among young women in the United States.
J Infect Dis. 2012 Feb;205(3):358-65. Epub 2012 Jan 11.
Hughes JP, Baeten JM, Lingappa JR, Magaret AS, Wald A, de Bruyn G, Kiarie J, Inambao M, Kilembe W, Farquhar C, Celum C; Partners in Prevention HSV/HIVTransmission Study Team. Collaborators (27)Source
Department of Biostatistics, University of Washington, Seattle firstname.lastname@example.org
Knowledge of factors that affect per-act infectivity of human immunodeficiency virus type 1 (HIV-1) is important for designing HIV-1 prevention interventions and for the mathematical modeling of the spread of HIV-1.
We analyzed data from a prospective study of African HIV-1-serodiscordant couples. We assessed transmissions for linkage within the study partnership, based on HIV-1 sequencing. The primary exposure measure was the HIV-1-seropositive partners’ reports of number of sex acts and condom use with their study partner.
Of 3297 couples experiencing 86 linked HIV-1 transmissions, the unadjusted per-act risks of unprotected male-to-female (MTF) and female-to-male (FTM) transmission were 0.0019 (95% confidence interval [CI], .0010-.0037) and 0.0010 (95% CI, .00060-.0017), respectively. After adjusting for plasma HIV-1 RNA of the HIV-1-infected partner and herpes simplex virus type 2 serostatus and age of the HIV-1-uninfected partner, we calculated the relative risk (RR) for MTF versus FTM transmission to be 1.03 (P = .93). Each log(10) increase in plasma HIV-1 RNA increased the per-act risk of transmission by 2.9-fold (95% CI, 2.2-3.8). Self-reported condom use reduced the per-act risk by 78% (RR = 0.22 [95% CI, .11-.42]).
Modifiable risk factors for HIV-1 transmission were plasma HIV-1 RNA level and condom use, and, in HIV-1-uninfected partners, herpes simplex virus 2 infection, genital ulcers, Trichomonas vaginalis, vaginitis or cervicitis, and male circumcision.
Comment in J Infect Dis. 2012 Feb;205(3):351-2
Gray RH, Wawer MJ.
J Infect Dis. 2012 Feb;205(3):351-2.
Probability of heterosexual HIV-1 transmission per coital act in sub-Saharan Africa.
Gray RH, Wawer, MJ .
HIV Testing, Diagnosis, Epidemological Issues (e.g. prevalence, incidence, mortality) Article Summaries
Epidemiol Infect. 2012 Mar 12:1-7. [Epub ahead of print]
Epidemiology of classic and AIDS-related Kaposi’s sarcoma in the USA: incidence, survival, and geographical distribution from 1975 to 2005.
Armstrong AW, Lam KH, Chase EP.
University of California Davis, Department of Dermatology, Sacramento, CA.
This study aimed to examine trends in incidence, geographical distribution, and survival of classic and AIDS-related Kaposi’s sarcoma (KS) in the general US population using Surveillance, Epidemiology, and End Results (SEER) tumour registries with 12 066 patients diagnosed with KS between 1975 and 2005. Although the age-adjusted standardized incidence ratio (SIR) of AIDS-related KS (1·9) during 1980-2005 was not significantly higher than that of classic KS (1·4) during 1975-2005 (P=0·78), the trends in annual SIR rates revealed distinct patterns. While the SIR for AIDS-related KS declined across all registries from the early 1990s (4·6) to late-1990s (0·3) (P=0·05), the SIR of classic KS remained relatively steady (1·7). In both forms the SIR of KS was highest in metropolitan areas. The 5-year survival rates for patients with AIDS-related KS improved from 12·1% (1980-1995) to 54% (1996-2005) (P=0·05). Survival rates for patients with classic KS remained stable, ranging from 75·7% to 88·6% during the 30-year period. These results may reflect improved HIV treatment.
Theor Biol Med Model. 2012 Mar 19;9(1):9.
Variable effect of co-infection on the HIV infectivity: Within-host dynamics and epidemiological significance.
Cuadros DF, Garcia-Ramos G.
BACKGROUND: Recent studies have implicated viral characteristics in accounting for the variation in the HIV set-point viral load (spVL) observed among individuals. These studies have suggested that the spVL might be a heritable factor. The spVL, however, is not in an absolute equilibrium state; it is frequently perturbed by immune activations generated by co-infections, resulting in a significant amplification of the HIV viral load (VL). Here, we postulated that if the HIV replication capacity were an important determinant of the spVL, it would also determine the effect of co-infection on the VL. Then, we hypothesized that viral factors contribute to the variation of the effect of co-infection and introduce variation among individuals.
METHODS: We developed a within-host deterministic differential equation model to describe the dynamics of HIV and malaria infections, and evaluated the effect of variations in the viral replicative capacity on the VL burden generated by co-infection. These variations were then evaluated at population level by implementing a between-host model in which the relationship between VL and the probability of HIV transmission per sexual contact was used as the within-host and between-host interface.
RESULTS: Our within-host results indicated that the combination of parameters generating low spVL were unable to produce a substantial increase in the VL in response to co-infection. Conversely, larger spVL were associated with substantially larger increments in the VL. In accordance, the between-host model indicated that co-infection had a negligible impact in populations where the virus had low replicative capacity, reflected in low spVL. Similarly, the impact of co-infection increased as the spVL of the population increased.
CONCLUSION: Our results indicated that variations in the viral replicative capacity would influence the effect of co-infection on the VL. Therefore, viral factors could play an important role driving several virus-related processes such as the increment of the VL induced by co-infections. These results raise the possibility that biological differences could alter the effect of co-infection and underscore the importance of identifying these factors for the implementation of control interventions focused on co-infection.
Int J STD AIDS. 2012 Feb;23(2):83-7.
Novak D, Novak M.
Department of Paediatrics, Queen Silvia Children’s Hospital.
Sweden was the first country to introduce online Chlamydia trachomatis testing for both men and women and this article provides information about the user characteristics and which risk groups are reached with this method. During the years 2005-2007 a questionnaire was administered with a response rate of 86% (n = 6025) (62.5% women, 37.5% men). Over 60% of respondents were aged below 26 years and single. The average years of education for men and women was 14 (range 9.0-26.0). The mean Internet usage time was 22.4 hours/week among men and 15.5 hours/week among women. Only 22% men and 34% women had tested themselves for C. trachomatis at clinics previously. Respondents reported a higher frequency of previous sexually transmitted infections (STIs) compared with other Internet users (i.e. C. trachomatis: men 19%, women 24%). Eighty percent of online test users had engaged in sex with ≥2 partners without a condom during the previous year. Online C. trachomatis test users are mostly young people with high sexual risk behaviour.
AIDS. 2012 Mar 14. [Epub ahead of print]
Yang J, Ge M, Pan XM.
The Key Laboratory of Bioinformatics, Ministry of Education, School of Life Sciences, Tsinghua University, Beijing, China; National Laboratory of Biomacromolecules, Center for Structure and Molecular Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.
OBJECTIVES: Identifying the direction of transmission in transmission pairs is important both for forensic investigations and for the monitoring of HIV epidemics, however, reliable methods are not yet available due to the long time lag between infection and sampling in most real cases.
DESIGNS: Based on bottleneck effect and coreceptor switching, we aimed at identifying an estimator from sequences of viral gp120 proteins to determine transmission direction between transmission pairs. The estimator should be changed with HIV transmission but was independent of disease progression in an individual.
METHODS: Here, we present a novel and reliable approach for identifying transmission direction. We derived a set of conserved patterns, called common patterns, from the sequences of viruses which differed in their coreceptor usage. The number of unique common patterns in viral sequences decreased with transmission but remained almost constant with the progress of disease in an individual. We used this number as an estimator to determine transmission direction in 73 transmission pairs for which the transmission direction was already known.
RESULTS: Our method predicted transmission direction with an accuracy of up to 94.5%. Of greater importance, our approach was not influenced by time lags between infection and sampling, and even transmission direction for transmission pairs with long time lags ranging from 2 years to more than 18 years were correctly determined.
CONCLUSIONS: Our approach for accurately determining transmission direction between transmission pairs is irrespective of the time lag between infection and sampling, which means a promising applications prospect.
AIDS. 2012 Mar 14. [Epub ahead of print]
Viral load monitoring of antiretroviral therapy, cohort viral load and HIV transmission in Southern Africa: A mathematical modelling analysis.
Estill J, Aubriere C, Egger M, Johnson L, Wood R, Garone D, Gsponer T, Wandeler G, Boulle A, Davies MA, Hallett T, Keiser O.
University of Bern, Switzerland; University of Cape Town, South Africa; Médecins Sans Frontières, Cape Town, South Africa; Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.
OBJECTIVES: In low-income settings treatment failure is often identified using CD4 cell count monitoring. Consequently, patients remain on a failing regimen, resulting in a higher risk of transmission. We investigated the benefit of routine viral load monitoring for reducing HIV transmission.
DESIGN: Mathematical model
METHODS: We developed a stochastic mathematical model representing the course of individual viral load, immunological response and survival in a cohort of 1,000 HIV infected patients receiving antiretroviral therapy (ART) in southern Africa. We calculated cohort viral load (sum of individual viral loads) and used a mathematical relationship between individual viral load values and transmission probability to estimate the number of new HIV infections. Our model was parameterized with data from the IeDEA Southern African collaboration. Sensitivity analyses were performed to assess the validity of the results in a universal ‘test and treat’ scenario where patients start ART earlier after HIV infection.
RESULTS: If CD4 cell count alone was regularly monitored, the cohort viral load was 2.6*10 copies/mL and the treated patients transmitted on average 6.3 infections each year. With routine viral load monitoring, both cohort viral load and transmissions were reduced by 31% to 1.7*10 copies/mL and 4.3 transmissions, respectively. The relative reduction of 31% between monitoring strategies remained similar for different scenarios.
CONCLUSIONS: While routine viral load monitoring enhances the preventive effect of ART, the provision of ART to everyone in need should remain the highest priority.
J Acquir Immune Defic Syndr. 2012 Mar 14. [Epub ahead of print]
Return to normal life after AIDS as a reason for lost to follow up in a community-based antiretroviral treatment program.
Alamo ST, Colebunders R, Ouma J, Sunday P, Wagner G, Wabwire-Mangen F, Laga M.
Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda; Institute of Tropical Medicine, Antwerp; University of Antwerp, Antwerp; Management Sciences for Health, Kampala, Uganda…
OBJECTIVES: To understand reasons for lost to follow-up (LTFU) from a community-based antiretroviral therapy (ART) program in Uganda.
STUDY DESIGN: Retrospective cohort of patients LTFU between May 31, 2001-May 31, 2010 was examined. A representative sample of 579 patients traced to ascertain their outcomes.
METHODS: Mixed methods were used. Using “stopped care” as the hazard and “self-transferred” as the comparator we examined using Cox proportional multivariable model, risk factors for stopping care.
RESULTS: Overall, 2933/3954(74.0%) patients were LTFU. Of 579/2933(19%) patients sampled for tracing, 32 (5.5%) were untraceable, 66(11.4 %) were dead and 481 (83.0%) found alive. Of those found alive, 232(40.0%) stopped care, 249(43.0%) self-transferred, while 61(12.7%) returned to care at ROM. In adjusted hazards ratios, born-again religion, originating from outside Kampala, resident in Kampala for < five years but > one year, having school-age children who were out of school, non HIV disclosure, CD4 counts >250 cells/mm3 and pre-ART were associated with increased risk of stopping care. Qualitative interviews revealed return to a normal life as a key reason for LTFU.Of 61 patients who returned to care, their median CD4 count at LTFU was higher than on return into care (401/mm3 vs. 205/mm3, P<0.0001).
CONCLUSION: Many patients become LTFU during the course of years, necessitating the need for effective mechanisms to identify those in need of close monitoring. Efforts should be made to improve referrals and mechanisms to track patients who transfer to different facilities. Additionally, tracing of patients who become LTFU is required to convince them to return.
Am J Public Health. 2012 Mar 15. [Epub ahead of print]
Payer Status, Race/Ethnicity, and Acceptance of Free Routine Opt-Out Rapid HIV Screening Among Emergency Department Patients.
Sankoff J, Hopkins E, Sasson C, Al-Tayyib A, Bender B, Haukoos JS.
Department of Emergency Medicine, Denver Health Medical Center, Denver; Denver Public Health, Denver; Department of Emergency Medicine, University of Colorado School of Medicine.
Objectives. We estimated associations between payer status, race/ethnicity, and acceptance of nontargeted opt-out rapid HIV screening in the emergency department (ED).
Methods. We analyzed data from a prospective clinical trial between 2007 and 2009 at Denver Health. Patients in the ED were offered free HIV testing. Patient demographics and payer status were collected, and we used multivariable logistic regression to estimate associations with HIV testing acceptance.
Results. A total of 31 525 patients made 44 765 unique visits: 40% were White, 37% Hispanic, 14% Black, 1% Asian, and 7% unknown race/ethnicity. Of all visits, 10 237 (23%) agreed to HIV testing; 27% were self-pay, 23% state-sponsored, 18% Medicaid, 13% commercial insurance, 12% Medicare, and 8% another payer source. Compared with commercial insurance patients, self-pay patients (odds ratio [OR] = 1.63; 95% confidence interval [CI] = 1.51, 1.75), state-sponsored patients (OR = 1.64; 95% CI = 1.52, 1.77), and Medicaid patients (OR = 1.24; 95% CI = 1.14, 1.34) had increased odds of accepting testing. Compared with White patients, Black (OR = 1.29; 95% CI = 1.21, 1.38) and Hispanic (OR = 1.17; 95% CI = 1.11, 1.23) patients had increased odds of accepting testing.
Conclusions. Many ED patients are uninsured or subsidized through government programs and are more likely to consent to free rapid HIV testing.
Am J Epidemiol. 2012 Mar 19. [Epub ahead of print]
Derivation and Validation of the Denver Human Immunodeficiency Virus (HIV) Risk Score for Targeted HIV Screening.
Haukoos JS, Lyons MS, Lindsell CJ, Hopkins E, Bender B, Rothman RE, Hsieh YH, Maclaren LA, Thrun MW, Sasson C, Byyny RL.
Targeted screening remains an important approach to human immunodeficiency virus (HIV) testing. The authors aimed to derive and validate an instrument to accurately identify patients at risk for HIV infection, using patient data from a metropolitan sexually transmitted disease clinic in Denver, Colorado (1996-2008). With multivariable logistic regression, they developed a risk score from 48 candidate variables using newly identified HIV infection as the outcome. Validation was performed using an independent population from an urban emergency department in Cincinnati, Ohio. The derivation sample included 92,635 patients; 504 (0.54%) were diagnosed with HIV infection. The validation sample included 22,983 patients; 168 (0.73%) were diagnosed with HIV infection. The final score included age, gender, race/ethnicity, sex with a male, vaginal intercourse, receptive anal intercourse, injection drug use, and past HIV testing, and values ranged from -14 to +81. For persons with scores of <20, 20-29, 30-39, 40-49, and ≥50, HIV prevalences were 0.31% (95% confidence interval (CI): 0.20, 0.45) (n = 27/8,782), 0.41% (95% CI: 0.29, 0.57) (n = 36/8,677), 0.99% (95% CI: 0.63, 1.47) (n = 24/2,431), 1.59% (95% CI: 1.02, 2.36) (n = 24/1,505), and 3.59% (95% CI: 2.73, 4.63) (n = 57/1,588), respectively. The risk score accurately categorizes patients into groups with increasing probabilities of HIV infection.
BMC Res Notes. 2012 Mar 19;5(1):154. [Epub ahead of print]
Baveewo S, Kamya MR, Mayanja-Kizza H, Fatch R, Bangsberg DR, Coates T, Hahn JA, Wanyenze RK.
BACKGROUND: Rapid HIV tests provide same-day results and are widely used in HIV testing programs in areas with limited personnel and laboratory infrastructure. The Uganda Ministry of Health currently recommends the serial rapid testing algorithm with Determine, STAT-PAK, and Uni-Gold for diagnosis of HIV infection. Using this algorithm, individuals who test positive on Determine, negative to STAT-PAK and positive to Uni-Gold are reported as HIV positive. We conducted further testing on this subgroup of samples using qualitative DNA PCR to assess the potential for false positive tests in this situation.
RESULTS: Of the 3388 individuals who were tested, 984 were HIV positive on two consecutive tests, and 29 were considered positive by a tiebreaker (positive on Determine, negative on STAT-PAK, and positive on Uni-Gold). However, when the 29 samples were further tested using qualitative DNA PCR, 14 (48.2%) were HIV negative.
CONCLUSION: Although this study was not primarily designed to assess the validity of rapid HIV tests and thus only a subset of the samples were retested, the findings show a potential for false positive HIV results in the subset of individuals who test positive when a tiebreaker test is used in serial testing. These findings highlight a need for confirmatory testing for this category of individuals.
Nurse Pract. 2012 Apr 15;37(4):40-6.
Champion JD, Collins JL.
Texas Tech University Health Sciences Center in Lubbock, TX
Screening, treatment, and counseling for sexually transmitted infections requires a thorough assessment of psychosocial, behavioral, cultural, and clinical factors. This article offers a summary of the most recent CDC data, prevention guidelines, and steps to implementing current evidence into clinical practice.
Neth J Med. 2012 Mar;70(2):69-73.
Hermans L, Wensing A, Hoepelman A, Dutihl J, Mudrikova T.
Departments of Virology, Medical Microbiology, Internal Medicine & Infectious Diseases, University Medical Center Utrecht, the Netherlands.
As HIV infection may be non-symptomatic for many years, many HIV-infected individuals are not aware of their infection. At a certain point in time non-specific symptoms may occur for which patients are likely be referred to internal medicine outpatient clinics. In the absence of systematic screening for HIV and in particular in patients who do not have classical risk factors for HIV, the diagnosis of HIV infection may easily be overlooked. In this manuscript it is illustrated that this diagnostic and therapeutic delay can lead to increased morbidity and mortality. Moreover, undiagnosed individuals are on average more likely to transmit HIV than diagnosed individuals. It is important for public health to identify people harbouring HIV infection, as this is expected to reduce the number of new infections. HIV infection should be considered a possible cause of unexplained symptoms in an early stage of the diagnostic process, in particular in patients with symptoms such as unexplained fever, lymphadenopathy or weight loss or in the presence of conditions suggestive of possible immune deficiency, regardless of the absence of risk factors.
Neth J Med. 2012 Mar;70(2):56-57.
Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
Best Pract Res Clin Obstet Gynaecol. 2012 Mar 17. [Epub ahead of print]
Vaginal microbicides to prevent human immunodeficiency virus infection in women: Perspectives on the female genital tract, sexual maturity and mucosal inflammation.
Roberts L, Liebenberg L, Barnabas S, Passmore JA.
Division of Medical Virology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Observatory, Cape Town, South Africa.
Topically applied vaginal microbicides to protect against human immunodeficiency (HIV) virus infection offer an important female-controlled prevention strategy. Microbicides have been in development for more than 2 decades, and have included various agents that disrupt cellular and microbial membranes (surfactants), restore the natural acidic protective pH of the vagina (acid buffers), and those that interfere with interactions between HIV envelope proteins and cellular receptors (anionic polymers). Although none of these candidate microbicides have shown significant protection against HIV in clinical trials, a topical gel, including the antiretroviral drug tenofovir (TFV) 1% was the first microbicide to be tested to show some protection against HIV infection. This review explores the effect of female genital tract biology and anatomy, mucosal inflammation, and age on the effectiveness of microbicides to prevent HIV infection.
J Acquir Immune Defic Syndr. 2012 Mar 14. [Epub ahead of print]
Patient attrition between diagnosis with HIV in pregnancy-related services and long-term HIV care and treatment services in Kenya: A retrospective study.
Ferguson L, Lewis J, Grant AD, Watson-Jones D, Vusha S, Ongʼech JO, Ross DA.
London School of Hygiene and Tropical Medicine, London, UK; University of Nairobi, Institute of Tropical and Infectious Diseases, Nairobi, Kenya; Aurum Institute for Health Research, Johannesburg, South Africa…
BACKGROUND: There has been little attention, until recently, to linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services.
METHODS: A retrospective review of routine hospital data was carried out in two hospitals in Kenya. Associations between available demographic information and uptake of HIV-related services within six months of HIV diagnosis in pregnancy-related services were assessed using logistic regression. Kaplan-Meier survival analysis was used to assess time between HIV diagnosis and registration at the HIV clinic. Referrals between pregnancy-related and HIV-related services were observed.
RESULTS: At Naivasha hospital, the proportion of women registering at the HIV clinic within six months was 17.2% (153/892); at Gilgil hospital it was 35.4% (84/237). Highly active antiretroviral therapy (HAART) was initiated by 40% and 27% of known-eligible women in Naivasha and Gilgil respectively. Non-systematic registration of clients on first contact at the HIV clinic, and restricted availability of services due to costs and opening hours were observed. In Naivasha, year, attendance at multiple pregnancy-related visits and attendance at antenatal care in Naivasha hospital were associated with registration at the HIV clinic. In Gilgil, year, attendance at multiple pregnancy-related visits, and women being in their first pregnancy were associated with the outcome.
CONCLUSION: Only 4% of women estimated to need HAART for their own care initiated HAART within six months of HIV diagnosis. Challenges associated with providing longitudinal care are especially evident in the context of high population mobility. Innovation in service delivery is required to improve uptake of services.
Cochrane Database Syst Rev. 2012 Mar 14;3:CD009755.
Siegfried N, Irlam JH, Visser ME, Rollins NN.
Department of Public Health and Primary Health Care, University of Cape Town, Cape Town, South Africa.
BACKGROUND: Micronutrient deficiencies are widespread and compound the effects of HIV disease; micronutrient supplements may be effective and safe in reducing this burden.
OBJECTIVES: To assess whether micronutrient supplements are effective and safe in reducing mortality and morbidity in pregnant and lactating women with HIV infection and their infants.
SEARCH METHODS: The review has been updated three times since publication in 2005. In reviews prior to this update (2011), we searched the CENTRAL, EMBASE, PubMed, and GATEWAY databases to identify randomised controlled trials of micronutrient supplements using the search methods of the Cochrane HIV/AIDS Group. In the 2011 review the PubMed, EMBASE, and CENTRAL databases were searched in July 2011. As the GATEWAY database does not include conference abstracts after 2006, we also searched the AIDS-specific conference database, www.aegis.org, and contacted researchers and organisations active in the field of research to identify additional unpublished trials.
SELECTION CRITERIA: Randomised controlled trials were selected that compared the effects of micronutrient supplements (vitamins, trace elements, and combinations of these) with other supplements, placebo or no treatment on mortality, morbidity, pregnancy outcomes, immunologic indicators, and anthropometric measures in HIV-positive pregnant and lactating women. Any adverse effects of supplementation were recorded.
DATA COLLECTION AND ANALYSIS: Two reviewer authors independently selected trials, appraised trial quality for risk of bias using standardised criteria, and extracted data using standardised forms. Where disagreements arose, a third author, acted as arbiter.
MAIN RESULTS: One additional trial is included in this update in addition to the three trials included in the 2010 update of the initial Cochrane review. Four relatively large, well-conducted randomised controlled trials of the benefits of micronutrient supplementation have been conducted in pregnant and lactating women infected with HIV. Each of the trials evaluated a different micronutrient supplement and no direct comparisons or analyses can be made across the four trials. The four trials were conducted between 1995 and 2006. The trials have all been conducted by the same research team in Dar es Salaam in Tanzania, in an urban setting in hospital-based antenatal clinics. Pregnant women were recruited with gestational age ranging from 12 to 27 weeks in each of the trials. Sample sizes range from 400 to 1129 with a median of 1000 participants. Three of the trials were placebo-controlled. Different interventions have been evaluated in each trial, viz.:Vitamin A versus Vitamin A and multivitamins versus Multivitamins versus placebo; Selenium versus placebo; Zinc versus placebo; and Multiple RDA multivitamins versus Single RDA multivitamins. None of the women were receiving antiretrovrial therapy (ART).Multiple micronutrient supplements conferred multiple clinical benefits to pregnant women and their offspring. No significant adverse effects were reported.No significant clinical benefits were found from zinc supplementation of pregnant Tanzanian women.Selenium supplements given during and after pregnancy did not delay maternal HIV disease progression or improve pregnancy outcomes, but may improve child survival and decrease maternal diarrhoeal morbidity.There were no differences in maternal and infant outcomes when women received single RDA multivitamins or multiple RDA multivitamin supplementation.The evidence is lacking for the effects of micronutrient supplementation given concomitantly to pregnant women already initiated on antiretroviral therapy for treatment purposes.GRADE assessments were conducted on outcomes for each trial and included reviewing the data and the potential biases in each trial before grading the level of evidence. None of the trials were graded as providing high quality evidence primarily because there was no replication of results in other trials in other settings.
AUTHORS’ CONCLUSIONS: In keeping with previous World Health Organization (WHO) recommendations everything possible should be done to promote and support adequate dietary intake of micronutrients, while recognising that this may not be sufficient to correct specific micronutrient deficiencies in all HIV-infected individuals.Specific recommendations for pregnant and lactating women infected with HIV would be to include the provision of multivitamin supplements in single RDA formulations during the antenatal period and at least for 6 weeks post-partum, especially for women who are breast-feeding.There is no conclusive evidence to provide stand-alone zinc or selenium supplementation to HIV-infected pregnant and lactating women.Micronutrient supplementation should not be used as a substitute for provision of recommended antiretroviral medication for preventing mother-to-child transmission of HIV and treating maternal HIV infection when this is recommended.Further trials of single supplements are required to build the evidence base. The long-term clinical benefits, adverse effects, and optimal formulation of multiple micronutrient supplements require further investigation in pregnant women at different stages of HIV infection.
Midwifery. 2012 Mar 12. [Epub ahead of print]
‘Let men into the pregnancy’-Men’s perceptions about being tested for Chlamydia and HIV during pregnancy.
Christianson M, Boman J, Essén B.
Department of Nursing, Umeå University, SE-901 85 Umeå, Sweden.
OBJECTIVE: to investigate how to prevent transmission of HIV and Chlamydia trachomatis (CT) by exploring whether screening of men during pregnancy may be an innovative way to reach men, to increase detection, and to avoid the present gendered responsibility.
DESIGN: an explorative research strategy with in-depth interviews and an analysis informed by grounded theory principles was used.
SETTING: the northern part of Sweden.
PARTICIPANTS: twenty men/becoming fathers in their twenties and early thirties were offered CT and HIV testing and were interviewed about their perceptions about being tested during pregnancy.
FINDINGS: Six categories emerged that concerned the men’s risk perceptions, reasons for not testing men, benefits and negative consequences associated with being tested, incentive measures for reaching men and the optional time for testing men during pregnancy. The majority of the men perceived their own risk for having CT or HIV to be close to zero, trusted their stable partner, and did not see men as transmitters. They did not understand how men could play a role in CT or HIV transmission or how these infections could negatively affect the child. However, few informants could see any logical reasons for excluding men from testing and the majority was positive towards screening men during the pregnancy.
KEY CONCLUSIONS: men’s sexual health and behaviour on social and biological grounds will affect the health of women and their children during pregnancy and childbirth. As long as expectant fathers do not count in this ‘triad’, there is a risk that CT and HIV infections in adults and infants will continue to be an unsolved problem.
IMPLICATIONS FOR PRACTICE: knowledge from this research can contribute to influencing the attitudes among health-care providers positively, and inspiring policy changes.
Ann Intern Med. 2012 Mar 14. [Epub ahead of print]
Moyer VA; on behalf of the U.S. Preventive Services Task Force.
Description: Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for cervical cancer.
Methods: The USPSTF reviewed new evidence on the comparative test performance of liquid-based cytology and the benefits and harms of human papillomavirus (HPV) testing as a stand-alone test or in combination with cytology. In addition to the systematic evidence review, the USPSTF commissioned a decision analysis to help clarify the age at which to begin and end screening, the optimal interval for screening, and the relative benefits and harms of different strategies for screening (such as cytology and co-testing).
Recommendations: This recommendation statement applies to women who have a cervix, regardless of sexual history. This recommendation statement does not apply to women who have received a diagnosis of a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to diethylstilbestrol, or women who are immunocompromised (such as those who are HIV positive). The USPSTF recommends screening for cervical cancer in women age 21 to 65 years with cytology (Papanicolaou smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and HPV testing every 5 years. See the Clinical Considerations for discussion of cytology method, HPV testing, and screening interval (A recommendation). The USPSTF recommends against screening for cervical cancer in women younger than age 21 years (D recommendation). The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. See the Clinical Considerations for discussion of adequacy of prior screening and risk factors (D recommendation). The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion (cervical intraepithelial neoplasia grade 2 or 3) or cervical cancer (D recommendation). The USPSTF recommends against screening for cervical cancer with HPV testing, alone or in combination with cytology, in women younger than age 30 years (D recommendation).
Clin Infect Dis. 2012 Mar 19. [Epub ahead of print]
Ford N, Singh K, Cooke GS, Mills EJ, von Schoen-Angerer T, Kamarulzaman A, du Cros P.
Médecins Sans Frontières, Geneva, Switzerland.
The need to improve access to care and treatment for chronic hepatitis C virus (HCV) infection in resource-limited settings is receiving increasing attention. Key priorities for scaling up HCV treatment and care include reducing the cost of current and future treatment; simplifying the package of care; identifying opportunities to shift specific tasks to nonspecialists to overcome human resource constraints; service integration with human immunodeficiency virus (HIV) clinics, prison health services, and needle syringe and oral substitution therapy programs; improving surveillance, monitoring, and research; encouraging patient and community engagement; focusing specifically on the needs of vulnerable groups; and increasing financial and political commitment. Many of these obstacles have been addressed in rolling out treatment for human immunodeficiency virus during the last decade, and a number of lessons can be drawn to help improve access to HCV care.
Clin Infect Dis. 2012 Mar 19. [Epub ahead of print]
Crum-Cianflone NF, Roediger MP, Moore DJ, Hale B, Weintrob A, Ganesan A, Eberly LE, Johnson E, Agan BK, Letendre S.
Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences.
Background. Sleep disturbances are reportedly common among persons infected with human immunodeficiency virus (HIV), but recent data, including comparisons with HIV-uninfected persons, are limited.
Methods. We performed a cross-sectional study among early-treated HIV-infected military beneficiaries (n = 193) to determine the prevalence and factors associated with insomnia (Pittsburgh Sleep Quality Index [PSQI]) and daytime sleepiness (Epworth Sleepiness Scale [ESS]). Data were compared with HIV-uninfected persons (n = 50) matched by age, sex, race or ethnicity, and military rank.
Results. Forty-six percent of HIV-infected persons had insomnia (PSQI >5), and 30% reported daytime drowsiness (ESS ≥10). The prevalence of insomnia and daytime sleepiness was not significantly higher compared with the HIV-uninfected group (38% [P = .30] and 20% [P = .18], respectively). In the multivariate model, factors associated with insomnia among HIV infected patients included depression (odds ratio [OR], 16.8; 95% confidence interval [CI], 2.0-142.1; P = .01), increased waist size (OR, 2.7; 95% CI, 1.4-5.1; P = .002), and fewer years of education (OR, 0.8; 95% CI, .7-.95; P = .006). Neurocognitive impairment (diagnosed in 19% of HIV-infected participants) was not associated with insomnia; however, HIV-infected persons with insomnia were 3.1-fold more likely to have a decline in activities of daily living than those without insomnia (23% vs 9%; P = .01). Only 18% of HIV-infected persons reported using a sleep medication at least weekly.
Conclusions. HIV-infected persons have a high prevalence of insomnia, but among an early-treated cohort this rate was not significantly higher compared with HIV-uninfected persons. Factors associated with insomnia among HIV-infected patients include depression and increased waist size. Prompt diagnosis and treatment of sleep disturbances are advocated and may improve quality of life.
Crit Rev Microbiol. 2012 Mar 16. [Epub ahead of print]
Janbaz KH, Qadir MI, Ahmad B, Sarwar A, Yaqoob N, Masood MI.
Faculty of Pharmacy, Bahauddin Zakariya University , Multan , Pakistan.
Tuberculosis is an infection of respiratory tract and Mycobacterium tuberculosis is the causative agent. Multidrug resistance and HIV-coinfection are the burning issues for tuberculosis. The management of drug resistance to tuberculosis is the necessity of the day so by taking effective and controlled measures and giving high doses of 2nd line drugs, we can minimize the death rate in TB. For the HIV-related TB infection, it is necessary to treat TB infection first so that effectiveness of antiretroviral therapy may not be altered and the transmission of M. tuberculosis to other healthy individuals of community could be prevented. All HIV positive individuals who are at a greater risk of acquiring TB infection, either due to suppressed immune system or unhealthy circumstances, must be investigated and if indicated must be treated effectively at immediate basis so that latent TB infection may not progress to active TB.
Prevention Science. 2012, Volume 13, Number 2, 173-182,
Abstract /1st page image http://www.springerlink.com/content/u2n46545125r0t2m/
This longitudinal study reports on the development and evaluation of a narrative intervention aimed at increasing human papillomavirus (HPV) vaccination among college women. The prevention of HPV is a public health priority due to its pervasiveness and relationship to cervical cancer, the second leading cause of cancer deaths among women worldwide. Pilot work utilizing culture-centric narrative theory guided development of the intervention content. Exemplification theory led to hypotheses comparing communication sources of the narrative messages (peer only, medical expert only, or a combination of the two source types) in a four-arm randomized controlled trial (N = 404; 18–26 year olds). The combined peer-expert narrative intervention nearly doubled vaccination compared to controls (22% vs. 12%). The pragmatic goal of increasing HPV vaccination and the theoretical predictions about message source were supported. As predicted, the inclusion of peer and medical expert sources plays a critical role in promoting HPV vaccination among college women. Furthermore, the intervention increased HPV vaccination by increasing vaccine self-efficacy and intent. Theoretical and practical implications for designing effective HPV vaccine messages are discussed.
Curr HIV/AIDS Rep. 2012 Mar 14. [Epub ahead of print]
O’Brien M, Markowitz M.
Division of Infectious Diseases, Cancer Institute, New York University School of Medicine, New York.
Abstract/1st page image: http://www.springerlink.com/content/0g377j8241kp1705/
Critical advances in the early diagnosis of HIV now allow for treatment opportunities during acute infection. It remains unclear whether treatment of acute HIV infection with antiretroviral therapy improves long-term clinical outcomes for the individual and current guidelines are not definitive in recommending therapy at this stage of infection. However, treatment of acute HIV infection may have short-term benefit on viral set point when compared to delayed therapy as well as reducing the risk of transmission to others. Herein we review the immunological and clinical literature to discuss whether we should treat acute HIV infection, both from the perspective of the individual HIV-infected patient and from the public health perspective. As transmission of drug-resistant HIV variants are of concern, we also review recent clinical trial data to provide recommendations for which specific antiretroviral treatment regimens should be considered for the treatment of acute HIV infection.
AIDS Care. 2012 Mar 20. [Epub ahead of print]
Is quality of life poorer for older adults with HIV/AIDS? International evidence using the WHOQOL-HIV.
Department of Psychology, WHO Field Centre for the Study of Quality of Life, University of Bath, Bath, UK.
Increasingly older adults are being diagnosed with HIV/AIDS. In 2002, UNAIDS indicated that 13 aspects of quality of life (QoL) were poorer for older adults, but only sparse, inconsistent cross-cultural evidence is available. This statement was investigated using a reliable, valid measure (the WHOQOL-HIV) distributed in nine cultures (eight countries). HIV positive and well adults (n = 2089) were assessed across 30 QoL facets; 403 were 40+ years. It was confirmed that sleep, fatigue and sex-life were poorer areas of QoL for older HIV adults than younger. Furthermore, they could be misinterpreted as normal ageing signs. Moreover, older people reported greater dependency on medication. However, older HIV adults had better QoL than expected on 11 dimensions; negative feelings, social inclusion, and several environmental and spiritual facets. This highlights the extent of poor QoL in younger adults. After accounting for culture and gender, overall QoL and health in older HIV adults was explained by eight facets comprising 61.3% of the variance. Social relationships were paramount, especially personal relationships (41%), but support and sex-life also. Energy, negative feelings, cognitions, financial resources and HIV symptoms also contributed. Social interventions for ageing communities would improve well-being. This evidence could support global ageing and HIV policy.
Antivir Ther. 2012 Mar 13. [Epub ahead of print]
J Acquir Immune Defic Syndr. 2012 Mar 14. [Epub ahead of print]
A randomized study of pharmacokinetics, efficacy and safety of two raltegravir plus atazanavir strategies in ART-treated adults.
Carey D, Pett SL, Bloch M, Wand H, Macrae K, Beileiter K, Ray JE, Boyd MA, Emery S, Cooper DA.
Kirby Institute/University of New South Wales, Sydney, Australia; Holdsworth House Medical Practice, Sydney, Australia; Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, Australia…
BACKGROUND: New antiretroviral drug classes provide opportunities to explore novel regimens.
METHODS: HIV+ adults (<50 copies/mL) receiving atazanavir (ATV) were randomized to raltegravir (RAL) 400mg + ATV 300mg twice daily (q12h) for 4 weeks followed by RAL 800mg + ATV/ritonavir 300/100mg once daily (q24h) for 4 weeks or vice versa. Validated assays quantitated RAL and ATV plasma concentrations. Primary endpoint was geometric mean ratio (GMR) of ATV minimum concentration (Cmin) for q24h/q12h. Equivalence was 90% confidence interval (CI) of GMR lying between 0.80-1.25. Participants could consent to a total 48-week follow up.
RESULTS: 25 males, mean age 45 (range, 35-57) years were evaluated. ATV and RAL demonstrated considerable pharmacokinetic variability. There was no period or sequence effect for PK parameters (p>0.1 all measures). 90% CIs of ATV GMR Cmin (1.30 [90% CI, 1.08, 1.58]) and RAL GMR Cmin (0.48 [90% CI, 0.31, 0.75]) demonstrated non-equivalence. 76% consented to follow up. There were no serious adverse events and no discontinuations due to adverse events (AEs) over 48 weeks; HIV-RNA remained undetectable.
CONCLUSIONS: In virologically suppressed adults regimens comprising ATV plus RAL were efficacious and safe. ATV q12h troughs were lower than ATV/RTV q24h; RAL q24h troughs were lower than q12h.
Antimicrob Agents Chemother. 2012 Mar 19. [Epub ahead of print]
Characterization in an ex vivo ectocervical model of UC781/Tenofovir Combination Gel Products for HIV-1 Prevention.
Cost M, Dezzutti CS, Clark MR, Friend DR, Akil A, Rohan LC.
Magee-Womens Research Institute, Pittsburgh, PA
HIV continues to be a problem worldwide. Topical vaginal microbicides represent one option being evaluated to stop the spread of HIV. With drug candidates that have a specific action against HIV now being studied, it is important that, when appropriate and based on mechanism of action, the drug permeates into the tissue so that it can be delivered to specific targets which reside there. Novel formulations of a nucleotide reverse transcriptase inhibitor tenofovir (TFV) and a non-nucleoside reverse transcriptase inhibitor UC781 have been developed and evaluated here. Gels with three distinct rheological properties were prepared. The three gels showed release both UC781 and TFV under in vitro conditions at concentrations equal to or above the reported EC(50). Concentrations in ectocervical tissues were well in excess of reported EC(50) values. The gels maintain ectocervical viability and prevent infection of ectocervical explants after HIV-1 challenge. The study successfully demonstrates the feasibility of this novel combination of anti-retroviral agents to be combined into an aqueous gel for use as an HIV preventative.
Antimicrob Agents Chemother. 2012 Mar 19. [Epub ahead of print]
Moltó J, Valle M, Miranda C, Cedeño S, Negredo E, Clotet B.
“Lluita contra la Sida” Foundation, HIV Clinic, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
The aim of this open-label, fixed-sequence study was to investigate the potential of the botanical supplement milk thistle (silymarin) to interact with the boosted protease inhibitor combination darunavir/ritonavir. Fifteen HIV-infected patients receiving antiretroviral therapy with darunavir/ritonavir (600/100 mg twice daily) for at least 4 weeks were included. Silymarin (150 mg every 8 hours) was added to the antiretroviral treatment from days 1 to 14. Darunavir concentrations in plasma were determined by high-performance liquid chromatography immediately before and 1, 2, 4, 6, 8, 10 and 12 hours after a morning dose of darunavir/ritonavir on day 0 and darunavir/ritonavir plus silymarin on day 14. Individual darunavir pharmacokinetic parameters were calculated by noncompartmental analysis and compared between days 0 and 14 by means of the geometric mean ratio (GMR) and its 90% confidence interval (CI). Median (interquartile range) age was 48 (44-50) years and body weight was 70 (65-84) kg. Silymarin was well tolerated and all participants completed the study. The GMR for darunavir coadministered with silymarin relative to darunavir alone was 0.86 (90% CI, 0.70-1.05) for the area under the concentration-time curve from 0 to 12 hours; 0.83 (90% CI, 0.80-0.98) for the maximum concentration, and 0.94 (90% CI, 0.73-1.19) for the concentration at the end of the dosing interval. In summary, coadministration of silymarin with darunavir/ritonavir seems to be safe in HIV-infected patients; no dose adjustment for darunavir/ritonavir seems necessary.
Effects of a reduced dose of stavudine on the incidence and severity of peripheral neuropathy in HIV-infected adults in South Africa.
Pahuja M, Grobler A, Glesby MJ, Karim F, Parker G, Gumede S, Naidoo K.
Division of Infectious Diseases, Weill Cornell Medical College, New York. email@example.com.
BACKGROUND: Although recent World Health Organization (WHO) guidelines recommend withdrawing stavudine (d4T) from first-line antiretroviral therapy (ART), it remains commonly used in resource-limited settings. In 2006, WHO recommended decreasing the dose of d4T from 40 mg to 30 mg to mitigate toxicities. We compared the incidence and severity of peripheral neuropathy by d4T dose in a retrospective cohort study.
METHODS: Patients’ charts from an ART-naive population at a rural clinic in KwaZulu-Natal, South Africa, were retrospectively reviewed for signs and symptoms of incident peripheral neuropathy and were graded for severity using the DAIDS scale. Patients enrolled prior to the WHO guideline change were included in the study if they were on d4T 40 mg for ≥6 months. After the guideline change all patients were initiated on d4T 30 mg.
RESULTS: A total of 475 patients were analysed, including 235 in the 40 mg cohort (152.7 person-years [py]) and 240 in the 30 mg cohort (244.7 py). Incidence of peripheral neuropathy was 90.4/100 py (95% CI 75.9, 106.8) in the 40 mg cohort versus 40.5/100 py (95% CI 32.9, 49.3) in the 30 mg group (incidence rate ratio 0.45; P<0.0001). There was no difference in proportion of severe peripheral neuropathy cases (grade 3/4) between the cohorts: 8.3% in the 40 mg group and 8.9% in the 30 mg group (P=1.0). In a multivariate analysis, risk of peripheral neuropathy was associated with increasing age (hazard ratio [HR] 1.65, 95% CI 1.24, 2.19), 40 mg dose (HR 2.1, 95% CI 1.61, 2.74) and concurrent tuberculosis therapy (HR 1.41, 95% CI 1.06, 1.87).
CONCLUSIONS: Incidence of peripheral neuropathy in the 40 mg cohort was extremely high and, although lower, the rate in the 30 mg cohort was nonetheless unacceptably high.
HIV Med. 2012 Mar 14. [Epub ahead of print]
The MONET trial: week 144 analysis of the efficacy of darunavir/ritonavir (DRV/r) monotherapy versus DRV/r plus two nucleoside reverse transcriptase inhibitors, for patients with viral load < 50 HIV-1 RNA copies/mL at baseline.
Arribas J, Clumeck N, Nelson M, Hill A, van Delft Y, Moecklinghoff C.
University Hospital La Paz, IdiPAZ, Madrid, Spain.
BACKGROUND: In the MONotherapy in Europe with Tmc114 (MONET) trial, darunavir/ritonavir (DRV/r) monotherapy showed noninferior efficacy vs. two nucleoside reverse transcriptase inhibitors (NRTIs) plus DRV/r at the primary 48-week analysis. The trial was continued to week 144 to assess the durability of the results.
METHODS: A total of 256 patients with viral load < 50 HIV-1 RNA copies/mL on current highly active antiretroviral therapy (HAART) for at least 6 months switched to DRV/r 800/100 mg once daily, either as monotherapy (n = 127) or with two NRTIs (n = 129). Treatment failure was defined as two consecutive HIV RNA levels above 50 copies/mL [time to loss of virological response (TLOVR)] by week 144, or discontinuation of study drugs.
RESULTS: Eighty-one per cent of patients were male and 91% were Caucasian, and they had a median baseline CD4 count of 575 cells/uL. More patients in the DRV/r monotherapy arm had hepatitis C virus coinfection at baseline than in the control arm (18% vs. 12%, respectively). By week 144, the percentage of patients with HIV RNA < 50 copies/mL [intent to treat (ITT), TLOVR, switch = failure method] was 69% vs. 75% in the DRV/r monotherapy and triple therapy arms [difference = -5.9%; 95% confidence interval (CI) -16.9%, +5.1%]; by a strict ITT analysis (switches not considered failures), the percentage of patients with HIV RNA < 50 copies/mL was 84% vs. 83.5%, respectively (difference = +0.5%; 95% CI -8.7%, +9.7%). Twenty-one and 13 patients had two consecutive HIV RNA results above 50 copies/mL in the DRV/r monotherapy arm and triple therapy arm, respectively, of whom 18 of 21 (86%) and 10 of 13 (77%) had HIV RNA < 50 copies/mL at week 144.
CONCLUSIONS: In this study, for patients with HIV RNA < 50 copies/mL at baseline, switching to DRV/r monotherapy showed noninferior efficacy to DRV/r plus two NRTIs in a strict ITT (switches not considered failures) analysis, but not in a TLOVR switch equals failure analysis.
Curr Pharm Biotechnol. 2012 Mar 20. [Epub ahead of print]
Bovolenta C, Porcellini S, Alberici L.
CB MolMed, SpA, Milano, Italy. firstname.lastname@example.org.
The multiple therapeutic approaches developed so far to cope HIV-1 infection, such as anti-retroviral drugs, germicides and several attempts of therapeutic vaccination have provided significant amelioration in terms of life-quality and survival rate of AIDS patients. Nevertheless, no approach has demonstrated efficacy in eradicating this lethal, if untreated, infection. The curative power of gene therapy has been proven for the treatment of monogenic immunodeficiensies, where permanent gene modification of host cells is sufficient to correct the defect for life-time. No doubt, a similar concept is not applicable for gene therapy of infectious immunodeficiensies as AIDS, where there is not a single gene to be corrected; rather engineered cells must gain immunotherapeutic or antiviral features to grant either short- or long-term efficacy mostly by acquisition of antiviral genes or payloads. Anti-HIV/AIDS gene therapy is one of the most promising strategy, although challenging, to eradicate HIV-1 infection. In fact, genetic modification of hematopoietic stem cells with one or multiple therapeutic genes is expected to originate blood cell progenies resistant to viral infection and thereby able to prevail on infected unprotected cells. Ultimately, protected cells will re-establish a functional immune system able to control HIV-1 replication. Sixty gene therapy clinical trials against AIDS employing different viral vectors and transgenes have been approved or are currently ongoing worldwide. This review will overview anti-HIV-1 infection gene therapy field evaluating strength and weakness of the transgenes and payloads used in the past and of those potentially exploitable in the future.
Bing Du Xue Bao. 2012 Jan;28(1):84-8.
[Article in Chinese]
Duan JM, Qiu JY, Tan SY, Liu SW, Li L.
First School of Clinical Medical Sciences, Guangzhou 510515, China. email@example.com
Semen-derived enhancer of viral infection(SEVI) is a peptide fragment (PAP248-286) from prostatic acid phosphatase(PAP), which can enhance human immunodeficiency virus infection. The mechanisms of SEVI include: (1) SEVI with several cationic amino acid residues reduced electrostatic repulsion between HIV virus and the target cells; (2) The disorder state of SEVI in the human body fluids was helpful to the interaction between virus and the target cell membranes; (3) SEVI could capture HIV particles directly and speed the velocity of virus on the surface of the target cells and improve adsorption and fusion. Currently, the substances of inhibiting SEVI activity include: EGCG from green tea, small molecule compound of aminoquinoline Surfen, ThT analogs BTA-EG6. Those compounds might block the combination of HIV and SEVI or prevent the formation of amyloid fibers, and then reduce the enhancement of SEVI. The studies on the biological characteristics and mechanisms of SEVI have a big benefit for the prevention and treatment of HIV infection.
DATE: 15 March 2012
Zimbabwe’s ambitious plan to offer an HIV test to every household in the country is not yet under way but is already being met with scepticism by activists who feel this is not a priority for the country, especially with global HIV/AIDS funding on the decline. Owen Mugurungi, national coordinator of the HIV/AIDS and Tuberculosis Unit, told IRIN/PlusNews the government wanted every sexually active Zimbabwean to know their status by 2015 by bringing HIV testing closer to the people… Tinashe Mundawarara, programme manager for the HIV/AIDS, Human Rights and Law Project at the Zimbabwe Lawyers for Human Rights, warns of the possibility of compromising on informed consent and confidentiality when testing is done on a large scale… In addition, the household testing campaign would require a lot of funding… Activists have also raised concerns about whether the testing campaign will go beyond merely testing people, and whether it will motivate them to change their sex ual behaviours and also refer those testing positive to treatment facilities… With limited money to scale up the provision of ARVs, the healthcare system would not have the capacity to treat those testing positive during the campaign, activists have cautioned. But Mugurungi insists government is focused on universal access to HIV prevention and treatment in line with the Millennium Development Goals and commitments of the UN High-Level Meeting on AIDS of June 2011…
12 March 2012
Russia’s top doctor said on Monday that new HIV infections rose 5 percent in 2011, with 62,000 cases recorded. According to Gennady Onishchenko, the country has logged more than 600,000 cases since 1987, a figure much lower than the UN’s estimate of 980,000. Onishchenko said heterosexual HIV transmission continues to increase and now accounts for 39.9 percent of cases, though most new cases are linked to injecting drug use. He worries that women are increasingly affected: Females now represent more than half of new infections in 13 Russian regions. According to activists, ongoing social stigma against the groups at highest risk — homosexuals and drug users — impedes Russia’s response to HIV/AIDS. International groups have long criticized Russia for failing to take a comprehensive approach. Andrei Zlobin, who leads Russia’s HIV patients association, said the official response to AIDS is marked by inefficiency, inaccurate data, and a lack of a plan. “The big question is wh y a country which spends so much materially lacks such efficiency,” he said.
Science. 2012 Mar 16;335(6074):1291.
A dramatic string of successes has buoyed the HIV prevention field over the past 2 years, but a troubling question has lingered: Why did a seemingly simple strategy work in some groups but not others? Last week’s 19th Conference on Retroviruses and Opportunistic Infections brought a sobering answer that may guide future prevention efforts. Research on ways to cure HIV infections also received more attention than ever…
Ending HIV-Related Health Disparities by Making HIV Prevention, Care, and Treatment Work for Women, 30 for 30 Campaign, March 2012
Ending HIV-Related Health Disparities by Making HIV Prevention, Care, and Tre…
Posted: 21 Mar 2012
This is a two-page executive summary of a series of briefing papers drafted by the 30 for 30 Campaign regarding women and HIV-related health disparities. The briefing papers “Making HIV Prevention Work for Women,” “Making HIV Care and Treatment Work …
By Ronald Valdiserri, M.D., M.P.H., Deputy Assistant Secretary for Health, Infectious Diseases, and Director, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services.
Introducing the Office of HIV/AIDS and Infectious Disease Policy
As announced in the Federal Register on Friday, March 16, the office formerly known as the Office of HIV/AIDS Policy will now be known as the Office of HIV/AIDS and Infectious Disease Policy (OHAIDP). OHAIDP, located within the Office of the Assistant Secretary for Health, is responsible for coordinating, integrating, and directing the Department of Health and Human Services’ policies, programs, and activities related to HIV/AIDS, viral hepatitis, other infectious diseases of public health significance, and blood safety and availability.
Mr. Christopher Bates, MPA, who has served as the Deputy Director of OHAP and Executive Director of the Presidential Advisory Council on HIV/AIDS (PACHA), begins a detail to PEPFAR this week. I want to take this opportunity to publicly thank my colleague Christopher for his service to HHS and for his commitment to addressing HIV/AIDS. Christopher joined OHAP in the second year of the Clinton Administration, bringing valuable experience and perspective from his prior work leading both the Philadelphia HIV Commission and the Washington, DC, Comprehensive AIDS Resources and CARE Consortium….
At the recent 19th Conference on Retroviruses and Opportunistic Infections (CROI), Dr. Ron Valdiserri, Deputy Assistant Secretary of Health for Infectious Diseases, spoke with Dr. Jonathan Mermin, Director of CDC’s Division of HIV/AIDS Prevention. They discussed some of the significant findings from the conference including advances related to pre-exposure prophylaxis (PrEP) and the growing discussions of an AIDS-free generation.