Using a dual antibody point-of-care test with visual and digital reads to diagnose syphilis among people living with HIV in Botswana

Syphilis data from low- and middle-income countries are lacking due to limited testing. Point-of-care tests (POCTs) have been promoted to expand testing but previously only included treponemal tests, which cannot distinguish active from past infection. We aimed to assess the feasibility of using a combined treponemal and non-treponemal POCT in HIV clinic patients in Gaborone, Botswana, and estimate syphilis prevalence in our clinic sample using this approach. We recruited 390 non-pregnant patients. Participants underwent a combined treponemal and non-treponemal POCT (Dual Path Platform (DPP®) Syphilis Screen and Confirm Assay (Chembio Diagnostic Systems)) on finger-prick blood sample and a questionnaire. Median age 45 years, 30% men, median CD4 count 565 cells/μL, and 91% had an HIV viral load <400 copies/mL. Five participants had active syphilis (1.3%, 95% CI 0.5-3.0%) and 64 had previous syphilis (16.4%, 95% CI 13.0-20.4%) using the DPP POCT. There was a reasonable level of agreement between digital and visual reading of the POCT (kappa statistic of 0.81); however, visual reading missed three active infections (60%). The level of active syphilis was similar to local antenatal data. The DPP POCT led to five participants with active syphilis being diagnosed and starting same-day treatment. The digital reader should be used

Key data from AIDS 2022

We report on the highlights ofthe 24th International AIDS Conference, held in Montreal in 2022. We address three main themes: human immunodeficiency virus (HIV) targets and cascades, HIV and sexually transmitted infection prophylaxis, and HIV treatment, including the use of antiretroviral therapy in pregnancy

Prolonged SARS-CoV-2 shedding in a person living with advanced HIV and diffuse large B-cell lymphoma: a case report

BACKGROUND: The global spread of SARS-CoV-2 has necessitated case isolation, with recommended isolation times based on mean time to viral clearance. CASE STUDY: We present a 28-year-old female living with vertically acquired HIV, undergoing chemotherapy for lymphoma who tested SARS-CoV-2-PCR positive for 164 days. The patient had a history of difficulty taking ARVs, with detectable HIV-RNA and CD4 count below 200 × 106 for the 8 years prior to presentation with symptoms. She stopped ARVs 10 months prior to experiencing fevers, night sweats and loose stool, with a viral load of 354,000 copies/ml and CD4 count of 30 × 106. Following no yield on basic investigations, positron emission tomography scan showed diffuse colonic and oesophageal avidity and a caecal biopsy showed diffuse large B-cell lymphoma. She re-started ARVs and underwent five cycles of R-CHOP chemotherapy. Her first positive SARS-CoV-2 PCR test was detected through routine asymptomatic screening. She self-isolated due to repeated positive tests on a further 8 swabs for a total of 164 days until a negative PCR test. She reported feeling low in mood and frustrated by repeated positive tests and the associated lack of social contact or ability to work. Her positive tests prevented in-person review by her HIV team, which impacted her ARV adherence leading to an unplanned break in therapy. CONCLUSIONS: Our case highlights the challenges to physical and mental health faced by patients with prolonged SARS-CoV-2 shedding and the need to develop surrogate markers for infectivity to enable prompt medical and psychological support and accurate advice about the need for isolation

Attenuated humoral responses in HIV after SARS-CoV-2 vaccination linked to B cell defects and altered immune profiles.

We assessed a cohort of people living with human immunodeficiency virus (PLWH) (n = 110) and HIV negative controls (n = 64) after 1, 2 or 3 SARS-CoV-2 vaccine doses. At all timepoints, PLWH had significantly lower neutralizing antibody (nAb) titers than HIV-negative controls. We also observed a delayed development of neutralization in PLWH that was underpinned by a reduced frequency of spike-specific memory B cells (MBCs). Improved neutralization breadth was seen against the Omicron variant (BA.1) after the third vaccine dose in PLWH but lower nAb responses persisted and were associated with global MBC dysfunction. In contrast, SARS-CoV-2 vaccination induced robust T cell responses that cross-recognized variants in PLWH. Strikingly, individuals with low or absent neutralization had detectable functional T cell responses. These PLWH had reduced numbers of circulating T follicular helper cells and an enriched population of CXCR3+CD127+CD8+T cells after two doses of SARS-CoV-2 vaccination