Sentinel surveillance of HIV-1 transmitted drug resistance, acute infection and recent infection.

BackgroundHIV-1 acute infection, recent infection and transmitted drug resistance screening was integrated into voluntary HIV counseling and testing (VCT) services to enhance the existing surveillance program in San Francisco. This study describes newly-diagnosed HIV cases and characterizes correlates associated with infection.Methodology/principal findingsA consecutive sample of persons presenting for HIV VCT at the municipal sexually transmitted infections (STI) clinic from 2004 to 2006 (N = 9,868) were evaluated by standard enzyme-linked immunoassays (EIA). HIV antibody-positive specimens were characterized as recent infections using a less-sensitive EIA. HIV-RNA pooled testing was performed on HIV antibody-negative specimens to identify acute infections. HIV antibody-positive and acute infection specimens were evaluated for drug resistance by sequence analysis. Multivariable logistic regression was performed to evaluate associations. The 380 newly-diagnosed HIV cases included 29 acute infections, 128 recent infections, and 47 drug-resistant cases, with no significant increases or decreases in prevalence over the three years studied. HIV-1 transmitted drug resistance prevalence was 11.0% in 2004, 13.4% in 2005 and 14.9% in 2006 (p = 0.36). Resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) was the most common pattern detected, present in 28 cases of resistance (59.6%). Among MSM, recent infection was associated with amphetamine use (AOR = 2.67; p<0.001), unprotected anal intercourse (AOR = 2.27; p<0.001), sex with a known HIV-infected partner (AOR = 1.64; p = 0.02), and history of gonorrhea (AOR = 1.62; p = 0.03).ConclusionsNew HIV diagnoses, recent infections, acute infections and transmitted drug resistance prevalence remained stable between 2004 and 2006. Resistance to NNRTI comprised more than half of the drug-resistant cases, a worrisome finding given its role as the backbone of first-line antiretroviral therapy in San Francisco as well as worldwide. The integration of HIV-1 drug resistance, recent infection, and acute infection testing should be considered for existing HIV/STI surveillance and prevention activities, particularly in an era of enhanced efforts for early diagnosis and treatment

Resurgence of HIV infection among men who have sex with men in Switzerland : mathematical modelling study

New HIV infections in men who have sex with men (MSM) have increased in Switzerland since 2000 despite combination antiretroviral therapy (cART). The objectives of this mathematical modelling study were: to describe the dynamics of the HIV epidemic in MSM in Switzerland using national data; to explore the effects of hypothetical prevention scenarios; and to conduct a multivariate sensitivity analysis. METHODOLOGY/PRINCIPAL FINDINGS: The model describes HIV transmission, progression and the effects of cART using differential equations. The model was fitted to Swiss HIV and AIDS surveillance data and twelve unknown parameters were estimated. Predicted numbers of diagnosed HIV infections and AIDS cases fitted the observed data well. By the end of 2010, an estimated 13.5% (95% CI 12.5, 14.6%) of all HIV-infected MSM were undiagnosed and accounted for 81.8% (95% CI 81.1, 82.4%) of new HIV infections. The transmission rate was at its lowest from 1995-1999, with a nadir of 46 incident HIV infections in 1999, but increased from 2000. The estimated number of new infections continued to increase to more than 250 in 2010, although the reproduction number was still below the epidemic threshold. Prevention scenarios included temporary reductions in risk behaviour, annual test and treat, and reduction in risk behaviour to levels observed earlier in the epidemic. These led to predicted reductions in new infections from 2 to 26% by 2020. Parameters related to disease progression and relative infectiousness at different HIV stages had the greatest influence on estimates of the net transmission rate. CONCLUSIONS/SIGNIFICANCE: The model outputs suggest that the increase in HIV transmission amongst MSM in Switzerland is the result of continuing risky sexual behaviour, particularly by those unaware of their infection status. Long term reductions in the incidence of HIV infection in MSM in Switzerland will require increased and sustained uptake of effective interventions

The Virgin HIV Puzzle: Can misreporting account for the high proportion of HIV cases in self-reported virgins?

The Demographic and Health Surveys from Lesotho, Zimbabwe, and Malawi reveal that a significant proportion of HIV infections in adolescent women occurred in women who claim to be virgin. Two possible conclusions arise from this observation: adolescent women misreport sexual status or non-sexual risk is more relevant than previously asserted. This paper uses a nonparametric model to estimate the proportion of HIV infections associated with sexual activity under different assumptions on data accuracy. It shows that there is an inverse relation between data accuracy and importance of sexual HIV transmission. If all adolescent women in the considered sub-sample correctly report sexual activity, 70% of HIV infections cannot be attributed to sexual HIV transmission. The model predicts that more than 95% of HIV infections are due to sexual HIV infections, if a substantial proportion of self-reported virgins (between 40 and 90%) misreport sexual status. --adolescent,HIV,misreporting,nonparametric modelling,sexual transmission

Black Americans and HIV/AIDS

Black Americans have been disproportionately affected by HIV/AIDS since the epidemic's beginning, and that disparity has deepened over time. Blacks account for more new HIV infections, people estimated to be living with HIV disease, and HIV-related deaths than any other racial/ethnic group in the U.S. The epidemic has also had a disproportionate impact on Black women, youth, and gay and bisexual men, and its impact varies across the country.Moreover, a number of challenges contribute to the epidemic among Blacks, including poverty, lack of access to health care, higher rates of some sexually transmitted infections, lack of awareness of HIV status, and stigma.Despite this impact, recent data indicate some encouraging trends, including declining new HIV infections among Black women.However, given the epidemic's continued and disproportionate impact among Blacks, a continued focus is critical to addressing HIV in the United States

Population-Level Benefits from Providing Effective HIV Prevention Means to Pregnant Women in High Prevalence Settings

Background:HIV prevalence among pregnant women in Southern Africa is extremely high. Epidemiological studies suggest that pregnancy increases the risk of HIV sexual acquisition and that HIV infections acquired during pregnancy carry higher risk of mother-to-child transmission (MTCT). We analyze the potential benefits from extending the availability of effective microbicide to pregnant women (in addition to non-pregnant women) in a wide-scale intervention.Methods and Findings:A transmission dynamic model was designed to assess the impact of microbicide use in high HIV prevalence settings and to estimate proportions of new HIV infections, infections acquired during pregnancy, and MTCT prevented over 10 years. Our analysis suggests that consistent use of microbicide with 70% efficacy by 60% of non-pregnant women may prevent approximately 40% and 15% of new infections in women and men respectively over 10 years, assuming no additional increase in HIV risk to either partner during pregnancy (RRHIV/preg = 1). It may also prevent 8-15% MTCT depending on the increase in MTCT risk when HIV is acquired during pregnancy compared to before pregnancy (RRMTCT/preg). Extending the microbicides use during pregnancy may improve the effectiveness of the intervention by 10% (RRHIV/preg = 1) to 25% (RRHIV/preg = 2) and reduce the number of HIV infections acquired during pregnancy by 40% to 70% in different scenarios. It may add between 6% (RRHIV/preg = 1, RRMTCT/preg = 1) and 25% (RRHIV/preg = 2, RRMTCT/preg = 4) to the reduction in the residual MTCT.Conclusion:Providing safe and effective microbicide to pregnant women in the context of wide-scale interventions would be desirable as it would increase the effectiveness of the intervention and significantly reduce the number of HIV infections acquired during pregnancy. The projected benefits from covering pregnant women by the HIV prevention programs is more substantial in communities in which the sexual risk during pregnancy is elevated. © 2013 Dimitrov et al

Peripartum infections and associated maternal mortality in rural Malawi

Article approval pendingTo assess associations between maternal mortality and severe morbidity and human immunodeficiency virus (HIV) infection, uptake of antiretroviral therapy, obstetric infections, and nonobstetric infections in a rural Malawian district, where the estimated HIV prevalence is 21%

The Impact of HAART on the Respiratory Complications of HIV Infection: Longitudinal Trends in the MACS and WIHS Cohorts

Objective: To review the incidence of respiratory conditions and their effect on mortality in HIV-infected and uninfected individuals prior to and during the era of highly active antiretroviral therapy (HAART). Design: Two large observational cohorts of HIV-infected and HIV-uninfected men (Multicenter AIDS Cohort Study [MACS]) and women (Women's Interagency HIV Study [WIHS]), followed since 1984 and 1994, respectively. Methods: Adjusted odds or hazards ratios for incident respiratory infections or non-infectious respiratory diagnoses, respectively, in HIV-infected compared to HIV-uninfected individuals in both the pre-HAART (MACS only) and HAART eras; and adjusted Cox proportional hazard ratios for mortality in HIV-infected persons with lung disease during the HAART era. Results: Compared to HIV-uninfected participants, HIV-infected individuals had more incident respiratory infections both pre-HAART (MACS, odds ratio [adjusted-OR], 2.4; 95% confidence interval [CI], 2.2-2.7; p<0.001) and after HAART availability (MACS, adjusted-OR, 1.5; 95%CI 1.3-1.7; p<0.001; WIHS adjusted-OR, 2.2; 95%CI 1.8-2.7; p<0.001). Chronic obstructive pulmonary disease was more common in MACS HIV-infected vs. HIV-uninfected participants pre-HAART (hazard ratio [adjusted-HR] 2.9; 95%CI, 1.02-8.4; p = 0.046). After HAART availability, non-infectious lung diseases were not significantly more common in HIV-infected participants in either MACS or WIHS participants. HIV-infected participants in the HAART era with respiratory infections had an increased risk of death compared to those without infections (MACS adjusted-HR, 1.5; 95%CI, 1.3-1.7; p<0.001; WIHS adjusted-HR, 1.9; 95%CI, 1.5-2.4; p<0.001). Conclusion: HIV infection remained a significant risk for infectious respiratory diseases after the introduction of HAART, and infectious respiratory diseases were associated with an increased risk of mortality. © 2013 Gingo et al

Know your HIV epidemic (KYE) report: review of the HIV epidemic in South Africa.

In order to update and consolidate South Africa’s evidence base for HIV-prevention interventions, it was decided by the Government of South Africa to commission a synthesis of the available data on the epidemiology of prevalent and incident HIV infections, and the wider epidemic context of these infections. This know your epidemic (KYE) approach has been successfully implemented in a number of sub-Saharan African countries.2 The process involves a desk review and secondary analysis of existing biological, behavioural and socio-demographic data in order to determine the epidemiology of new HIV infections. KYE reports present key findings and policy and programme recommendations which are grounded in local evidence and aim to support decision-making and improve HIV-prevention results. In 2010, South Africa also conducted a know your response (KYR) review, which critically assessed HIV-prevention policies, programmes and resource allocations. The overall results of this HIV epidemic review and the KYR review will be published in a separate, national KYE/KYR synthesis report

Prevalence of HIV, HBV and Chlamydia infections in Cameroonian University context: case of the University of Dschang, in the Western Region

Introduction: In sub-Saharan Africa HIV infection remains largely epidemic, whereas HBV infection is highly endemic (>8%). In Cameroon, HIV prevalence is 4.3%. Concerning HBV and chlamydia infections, their prevalence are both ≥10%. Young adults, including university students, are the population groups mostly affected. Epidemiological data on these infections, among university students could be helpful to implement specific prevention strategies. Methods: A descriptive study was performed in May 2013 among 624 students from the University of Dschang, Cameroon. Participants were screened for HIV, HBV and Chlamydia infections. Data was collected by a standard questionnaire and analyzed by Epi Info. Results: Average age of participants was 23.3 years (σ = 3.2) with female predominance (58.7%). Prevalence of HIV, HBV and Chlamydia infection was 1.1% (7/624), 2.8% (5/176) and 2.0% (2/100) respectively. 83.2% of participants were sexually active. Concerning sexual risk behaviors, participants reported having multi partners (14.8%), using condom occasionally (58.6%) or never (5.0%). 100%, 62.6% and 52.2% reported to be aware on HIV, HBV and Chlamydia infections respectively. In addition, only 5.5% and 21.3% of the participants were aware of their HBV and Chlamydia status respectively, versus 64.4% for HIV. The excessive cost of HBV and Chlamydia tests has been identified as the major barrier to testing (87.6%). Conclusion: Among college Cameroonian students the prevalence of HIV, HBV and Chlamydia infections seems to be relatively low if compared to general population. However, having multiple sexual partners in addition to non-systematic use of condoms during sexual intercourse represents risk behaviors among students. Awareness campaigns and screening facilitation on HBV and chlamydia infections need to be strengthened

Parallel and overlapping Human Immunodeficiency Virus, Hepatitis B and C virus Infections among pregnant women in the Federal Capital Territory, Abuja, Nigeria

Background: Risk factors that are associated with HIV infection are also associated with HBV and HCV infections in sub-Saharan Africa. The HIV-infected pregnant cohort represents a unique population and infection with the hepatitis virus is considered a public health problem worldwide. Objective: The purpose of this study was to evaluate the prevalence of Human Immunodeficiency Virus, Hepatitis B and C virus parallel and overlapping infections among pregnant women attending antenatal clinics in Federal Capital Territory (FCT), Abuja. Method: Five hundred (500) blood samples were collected from three district hospitals in the FCT and tested at Wuse General Hospital, Abuja for the presence of antibodies to HIV and Hepatitis C virus, and HBsAg by ELISA technique in accordance with the manufacturer’s instructions. HIV seropositive sera were confirmed by Western blot. Result: Of the 500 pregnant women, those detected with HIV antibodies, HBsAg and anti-HCV antibodies were 42 (8.4%), 19 (3.8%) and 8 (1.6%) respectively. The overall seroprevalence of HIV and HBV or HCV co-infection was 9.5% while 7.1% and 2.4% HIV positive pregnant women were specifically co-infected with HBV and HCV respectively. Those within the age bracket of 15-20 years had the highest prevalence of HIV (13.4%), HBV (5.1%) and HCV (1.9%) infections. Among the occupation characteristics of the women, those of them involved in trading recorded the highest prevalence of HIV (60.6%), HBV (30.3) and HCV (6.1%). HIV was higher among the married women than the singles ((8.6% vs 6.5%); with HBV infection the reverse was the case (3.0% vs 9.8%) while HCV was same for both groups. History of blood transfusion did not reflect a higher rate of HIV and HBV (1.4% vs 9.6%; 2.8% vs 4.0% respectively) unlike HCV infection with 0.5% recorded only among those that had transfusion experience. Conclusion: When monitoring the risk of hepatotoxicity to antiretroviral drugs among these group of patients caution should be maintained. Moreover, evidence of parallel and overlapping HIV, HBsAg and HCV infections among this cohort should motivate inclusion of HBV and HCV among the diseases of surveillance in the national sentinel survey in order to ascertain the bigger picture of these infections in Nigeria