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Background: Kenya’s HIV epidemic is heterogeneously distributed. Although HIV incidence in Kenya has shown signs of recent decline, focused interventions are still needed for female sex workers (FSWs). Geo-spatially-informed approaches have been advocated for targeted HIV prevention. We quantified heterogeneity in HIV burden in Nairobi-based FSWs by place of origin within Kenya, and hotspots and residence within Nairobi. Methods: Data were collected as part of enrolment in the Sex Workers Outreach Program (SWOP) in Nairobi between 2014 to 2017. Prevalence ratios (PRs) were used to quantify the risk of HIV by high prevalence counties (HPC) using modified Poisson regression analyses. Crude and fully adjusted models were fitted to the data. In heterogeneity analyses, hotspots and residences were aggregated to the Nairobi constituency level (n=17). Inequality in the geographic distribution of HIV prevalence was measured using the Gini coefficient. Results: A total of 11,899 FSWs were included. Overall HIV prevalence was 16%. FSWs originating from HPC were at 2-fold increased risk of living with HIV in adjusted analysis (PR 1.95, 95% CI: 1.76-2.17). HIV prevalence was also highly heterogeneous by hotspot, ranging from 7% to 52% by hotspot (Gini coefficient: 0.37; 95% CI: 0.23-0.50). In contrast, constituency of residence had a Gini coefficient of 0.08 (95% CI: 0.06-0.10), suggesting minimal heterogeneity by residence. Conclusion: HIV prevalence in FSW is heterogeneous by place of work within Nairobi, and by county of birth within Kenya. As HIV incidence declines and financial commitments flatline, tailoring interventions to FSWs at highest HIV risk becomes increasingly important. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Background: People with schizophrenia experience unique barriers to routine HIV testing, despite increased risk of HIV compared to the general US population. Little is known about how healthcare delivery system factors impact testing rates or whether there are testing differences for people with schizophrenia. Setting: Nationally representative sample of Medicaid enrollees with and without schizophrenia. Methods: Using retrospective longitudinal data, we examined whether state-level factors were associated with differences in HIV testing among Medicaid enrollees with schizophrenia compared to frequency matched controls during 2002–2012. Multivariable logistic regression estimated testing rate differences between and within cohorts. Results: Higher HIV testing rates for enrollees with schizophrenia was associated with higher state-level Medicaid spending per enrollee, efforts to reduce Medicaid fragmentation, and higher federal prevention funding. State-level AIDS epidemiology predicted more frequent HIV testing for enrollees with schizophrenia versus controls. Living in rural settings predicted lower HIV testing, especially for people with schizophrenia. Conclusion: Overall, state-level predictors of HIV testing rates varied among Medicaid enrollees, though rates were generally higher for those with schizophrenia than controls. Increased HIV testing for people with schizophrenia was associated with coverage of HIV testing when medically necessary, higher CDC prevention funding, and higher AIDS incidence, prevalence, and mortality when compared to controls. This analysis suggests that state policymaking has an important role to play in advancing that effort. Overcoming fragmented care systems, sustaining robust prevention funding, and consolidating funding streams in innovative and flexible ways to support more comprehensive systems of care delivery deserve attention. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Background: Sodium glucose transporter inhibitors have been approved for treatment of diabetes mellitus (DM), chronic kidney disease (CKD), and heart failure (HF), but little is known about prescription levels and safety profiles among PWH. Methods: We leveraged data from the U.S. Mass General Brigham (MGB) electronic healthcare database to determine the use/uptake of SGLT2 inhibitors among PWH with DM2 (with or without CKD, proteinuria, or HF) and to assess rates of adverse events among PWH with DM2 taking SGLT2 inhibitors. Results: Among eligible PWH with DM2 receiving care at MGB (N=907), SGLT2 inhibitors were prescribed to 8.8%. SGLT2 inhibitors were prescribed to a fraction of eligible PWH with DM2 and a concomitant diagnosis of either CKD (3.8%), proteinuria (13.2%), or HF (8.2%). PWH with DM2 on SGLT2 inhibitors experienced side effects (urinary tract infection, diabetic ketoacidosis, acute kidney injury) at rates comparable to PWH with DM2 prescribed GLP-1 agonists. Rates of mycotic genitourinary infections were higher among those prescribed SGLT2 inhibitors (5% vs. 1%, P = 0.17), but no cases of necrotizing fasciitis ensued. Conclusions: Additional studies are needed to characterize population-specific salutary and adverse effects of SGLT2 inhibitors among PWH and potentially augment prescription rates when guideline indicated. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

Objective: Determine if patient-centered, streamlined HIV care achieves higher ART uptake and viral suppression than the standard treatment model for people with HIV (PWH) reporting hazardous alcohol use. Design: Community cluster-randomized trial Methods: The SEARCH trial (NCT01864603) compared an intervention of annual population HIV testing, universal ART, and patient-centered care to a control of baseline population testing with ART by country standard in 32 Kenyan and Ugandan communities. Adults (≥15 years) completed a baseline Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and were classified as no/non-hazardous (AUDIT-C 0-2 women/0-3 men) or hazardous alcohol use (≥3 women/≥4 men). We compared year 3 ART uptake and viral suppression of PWH reporting hazardous use between intervention and control arms. We compared alcohol use as a predictor of year 3 ART uptake and viral suppression among PWH, by arm. Results: Of 11,070 PWH with AUDIT-C measured, 1723 (16%) reported any alcohol use; 893 (8%) reported hazardous use. Among PWH reporting hazardous use, the intervention arm had higher ART uptake (96%) and suppression (87%) compared to control (74%, aRR=1.28, 95%CI:1.19-1.38; and 72%, aRR=1.20, 95%CI:1.10-1.31, respectively). Within arm, hazardous alcohol use predicted lower ART uptake in control (aRR=0.86, 95%CI:0.78-0.96), but not intervention (aRR=1.02, 95%CI:1.00-1.04); use was not predictive of suppression in either arm. Conclusion: The SEARCH intervention improved ART uptake and viral suppression among PWH reporting hazardous alcohol use and eliminated gaps in ART uptake between PWH with hazardous and no/non-hazardous use. Patient-centered HIV care may decrease barriers to HIV care for PWH with hazardous alcohol use. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Background: The COVID-19 pandemic led to an increase in the number of deaths among all populations, including people with diagnosed HIV (PWDH). The aim of this study was to analyze the top causes of death (COD) among PWDH prior to the start of the COVID-19 pandemic, during the start of the COVID-19 pandemic, and a year later, to determine changes in the leading COD among PWDH, as well as determine if the historical trend of decreasing deaths related to HIV continued through the pandemic. Methods: To examine mortality among PWDH in New York State (NYS), records for PWDH who died from 2015-2021 were extracted from the NYS HIV registry and Vital Statistics Death Data. Results: The number of deaths among PWDH in New York State (NYS) increased 32% from 2019 to 2020 and continued in 2021. COVID-19 was one of the most common underlying COD among PWDH in 2020. In 2021, COVID-19 related deaths decreased while HIV and diseases of the circulatory system remained the top COD. HIV listed as either the underlying or contributing COD showed a consistent downward trend in the percentage of HIV related deaths among PWDH, from 45% in 2015 to 32% in 2021. Conclusions: There was a large increase in deaths among PWDH in 2020, with a substantial percent related to COVID-19. However, even with the introduction of COVID-19 in 2020, the percentage of deaths related to HIV— one of the goals of the Ending the Epidemic Initiative in NYS—continued to decrease. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

Background: We evaluated factors associated with lack of triple vaccination (hepatitis A (HAV), hepatitis B (HBV), human papilloma virus (HPV)] among men who have sex with men (MSM) using pre-exposure prophylaxis (PrEP). Setting: PrEP users at San Raffaele Scientific Institute, Italy, with ≥1 follow-up visit (May 2017-2022). Methods: Participants were considered protected if: i) prior to PrEP access: positive serology (IgG-HAV+, HbsAb>10mUI/ml) or vaccination history were recorded; ii) after starting PrEP: ≥1 dose of each vaccination was administered. Individuals were considered fully protected if they received before/during PrEP access: HAV vaccination/infection, HBV vaccination/infection and HPV vaccination. Chi-square and Kruskal-Wallis tests were used to compare characteristics of those fully, partially and not protected. Factors associated with lack of triple vaccination were assessed by multivariable logistic regression and classification tree analysis. Results: Overall, 473 MSM were considered: 146 (31%) were fully protected, 231 (48%) partially and 96 (20%) not. Daily-based PrEP users (fully:93, 63.7%; partially:107, 46.3%; not protected:40, 41.7%; p=0.001) and those with a sexually transmitted infection (STI) at first visit (43, 29.5%; 55, 23.8%; 15, 15.6%; p=0.048) were more frequently fully protected. At multivariable analysis, the odds of lack of triple vaccination was lower among daily-based users (adjusted odds ratio=0.47, 95%CI=0.31-0.70, p…

Neutralizing antibodies (NAbs) protect against HIV-1 acquisition in animal models and show promise in treatment of infection. They act by binding to the viral envelope glycoprotein (Env), thereby blocking its ...

AbstractBackgroundIncreased renin angiotensin aldosterone system(RAAS) activity may contribute to excess cardiovascular disease in people with HIV(PWH). We investigated how RAAS blockade may improve myocardial perfusion, injury and function among well-treated PWH.Methods40 PWH, on stable ART, without known heart disease were randomized to eplerenone 50 mg PO BID(n=20) or identical placebo(n=20) for 12 months. The primary endpoints were: 1) myocardial perfusion assessed by coronary flow reserve(CFR) on cardiac PET or stress myocardial blood flow(sMBF) on cardiac MRI or 2) myocardial inflammation by extracellular mass index(ECMi) on cardiac MRI.ResultsBeneficial effects on myocardial perfusion were seen for sMBF by cardiac MRI[mean(SD) 0.09(0.56) vs. -0.53(0.68)mL/min/g, P=.03], but not CFR by cardiac PET[0.01(0.64) vs. -0.07(0.48), P=.72, eplerenone vs. placebo]. Eplerenone improved parameters of myocardial function on cardiac MRI including left ventricular end diastolic volume[-13(28) vs. 10(26)mL, P=.03] and global circumferential strain[median (GCS, median(interquartile range 25th-75th), -1.3(-2.9-1.0) vs. 2.3(-0.4-4.1)%, P=.03], eplerenone vs. placebo respectively. On cardiac MRI, improvement in sMBF related to improvement in GCS(ρ=-0.65, P=.057) among those treated with eplerenone. Selecting for those with impaired myocardial perfusion(CFR

AbstractIntroductionPatients without HIV infection are increasingly recognised to be at risk for cryptococcosis. Knowledge of characteristics of cryptococcosis in these patients remains incomplete.MethodsWe conducted a retrospective study of cryptococcosis in 46 Australian and New Zealand hospitals to compare its frequency in patients with and without HIV, and describe its characteristics in patients without HIV. Patients with cryptococcosis between January 2015 and December 2019 were included.ResultsOf 475 patients with cryptococcosis, 90% were HIV-negative (426/475) with the marked predominance of HIV-negative cases evident in both Cryptococcus neoformans (88.7%) and C. gattii cases (94.3%). Most patients without HIV (60.8%) had a known immunocompromising condition: cancer (n=91), organ transplantation (n=81), other immunocompromising condition (n=97). Cryptococcosis presented as incidental imaging findings in 16.4% of patients (70/426). The serum cryptococcal antigen test was positive in 85.1 % of tested patients (319/375); high titres independently predicted risk of central nervous system involvement. Lumbar puncture was performed in 167 patients to screen for asymptomatic meningitis, with a positivity rate of 13.2% where meningitis could have been predicted by a high serum cryptococcal antigen titre and/or fungaemia in 95% of evaluable cases. One-year all-cause mortality was 20.9% in patients without HIV and 21.7% in patients with HIV (p=0.89).ConclusionThe present study revealed 90% of cryptococcosis cases occurred in patients without HIV (89% and 94% for C. neoformans and C. gattii cases, respectively). Emerging patient risk groups were evident. A high level of awareness is warranted to diagnose cryptococcosis in patients without HIV.

AbstractBackgroundThe lateral flow urine lipoarabinomannan assay, Determine TB-LAM (Determine LAM), offers the potential for timely tuberculosis (TB) treatment among people living with HIV (PWH).MethodsIn this cluster-randomized trial, Determine LAM was made available with staff training with performance feedback at three hospitals in Ghana. Newly admitted PWH with a positive WHO four-symptom screen for TB, severe illness, or advanced HIV were enrolled. The primary outcome was days from enrollment to TB treatment initiation. We also reported the proportion of patients with a TB diagnosis, initiating TB treatment, all-cause mortality, and Determine LAM uptake at 8 weeks.ResultsWe enrolled 422 patients including 174 (41.2%) in the intervention group. The median CD4 count was 87 cells/mm3 (IQR 25-205) and 138 patients (32.7%) were on antiretroviral therapy. More patients were diagnosed with TB in the intervention group compared with the control group, 59 (34.1%; 95%CI27.1-41.7) vs 46 (18.7%; 95%CI14.0-24.1), p

AbstractBackgroundHistoplasmosis is a major AIDS-defining illness in Latin America. Liposomal amphotericin B (L-AmB) is the drug of choice for treatment, but access is restricted due to the high drug and hospitalization costs of the conventional long regimens.MethodsProspective randomized multicenter open-label trial of one or two-dose induction therapy with L-AmB versus control for disseminated histoplasmosis in AIDS, followed by oral itraconazole therapy. We randomized subjects to: (i) Single dose 10 mg/kg of L-AmB; (ii) 10 mg/kg of L-AmB on D1, and 5 mg/kg of L-AmB on D3; (iii) 3 mg/kg of L-AmB daily for 2 weeks (control). The primary outcome was clinical response (resolution of fever and signs/symptoms attributable to histoplasmosis) at day 14.ResultsA total of 118 subjects were randomizedMedian CD4+ counts and clinical presentations were similar between arms. Infusion-related toxicity, kidney toxicity at multiple time-points and frequency of anemia, hypokalemia, hypomagnesemia, and liver toxicity were similar. Day 14 clinical response was 84% for Single-dose L-AmB, 69% Two-dose L-AmB, and 74% Control arm (p=0.69). Overall survival on D14 was 89.0% (34/38) for Single-dose L-AmB, 78.0% (29/37) for Two-dose L-AmB, and 92.1% (35/38) for Control arm (p=0.82).ConclusionsOne day induction therapy with 10 mg/kg of L-AmB in AIDS-related histoplasmosis was safe. Although clinical response may be non-inferior to standard L-AmB therapy, a confirmatory phase III clinical trial is needed. A single induction dose would markedly reduce drug-acquisition costs (>4-fold) and markedly shorten and simplify treatment, which are key points in terms of increased access.

Although a disproportionate number of mpox cases—between 35% and 47%, according to some studies—occur in people who also have HIV infection, research comparing the safety and outcomes of mpox treatments in patients with and without HIV is lacking.

AbstractThe World Health Organization recommends same-day initiation of antiretroviral therapy (ART) for all persons diagnosed with HIV and ready to start treatment. Evidence, mainly from randomized trials, indicates offering same-day ART increases engagement in care and viral suppression during the first year. In contrast, most observational studies using routine data find same-day ART to be associated with lower engagement in care. We argue that this discrepancy is mainly driven by different time points of enrolment leading to different denominators. While randomized trials enroll individuals when tested positive, most observational studies start at the time-point when ART is initiated. Thus, most observational studies omit those who are lost between diagnosis and treatment, thereby introducing a selection bias in the group with delayed ART. In this viewpoint, we summarize the available evidence and argue that the benefits of same-day ART outweigh a potential higher risk of attrition from care after ART initiation.

by Mário Songane, Célia C. Magaia, Aleny Couto, Nataniel Dengo, Abdul R. Cassamo, Rene Nhantumbo, Carlos Mahumane, Atanásio Mabote, Silvia Mikusova, Amâncio Nhangave, Nilesh Bhatt, Sushant S. Mukherjee Background In Mozambique, 38.7% of women and 60.4% of men ages 15–59 years old living with HIV do not know their HIV status. A pilot home-based HIV counseling and testing program based on index cases in the community was implemented in eight districts in Gaza province (Mozambique). The pilot targeted the sexual partners, biological children under 14 years old living in the same household, and parents (for pediatric cases) of people living with HIV. The study aimed to estimate the cost-efficiency and effectiveness of community index testing and compare the HIV testing outputs with facility-based testing. Methods Community index testing costs included the following categories: human resources, HIV rapid tests, travel and transportation for supervision and home visits, training, supplies and consumables, and review and coordination meetings. Costs were estimated from a health systems perspective using a micro-costing approach. All project costs were incurred between October 2017 and September 2018 and converted to U.S. dollars ($) using the prevailing exchange rate. We estimated the cost per individual tested, per new HIV diagnosis, and per infection averted. Results A total of 91,411 individuals were tested for HIV through community index testing, of which 7,011 were newly diagnosed with HIV. Human resources (52%), purchase of HIV rapid tests (28%) and supplies (8%) were the major cost drivers. The cost per individual tested was $5.82, per new HIV diagnosis was $65.32, and per infection averted per year was $1,813. Furthermore, the community index testing approach proportionally tested more males (53%) than facility-based testing (27%). Conclusion These data suggest that expansion of the community index case approach may be an effective and efficient strategy to increase the identification of previously undiagnosed HIV-positive individuals, particularly males. …

Abstract Background The Gambian Ministry of Health is supportive of HIV self-testing (HIVST) and HIVST initiatives are being piloted as an additional strategy to increase HIV testing for individuals not currently reached by existing services, particularly men. This study aimed to determine awareness of HIVST among Gambian men, and whether prior awareness of HIVST is associated with recent HIV testing uptake. Methods We used men’s cross-sectional data from the 2019–2020 Gambian Demographic and Health Survey. We employed design-adjusted multivariable logistic regression to examine the association between HIVST awareness and recent HIV testing. Propensity-score weighting was conducted as sensitivity analyses. Results Of 3,308 Gambian men included in the study, 11% (372) were aware of HIVST and 16% (450) received HIV testing in the last 12 months. In the design-adjusted multivariable analysis, men who were aware of HIVST had 1.76 times (95% confidence interval: 1.26–2.45) the odds of having an HIV test in the last 12 months, compared to those who were not aware of HIVST. Sensitivity analyses revealed similar findings. Conclusion Awareness of HIVST may help increase the uptake of HIV testing among men in Gambia. This finding highlights HIVST awareness-raising activities to be an important intervention for nationwide HIVST program planning and implementation in Gambia. …

Abstract Objectives To make clear the roles of social interaction and social support in HIV infection among elderly men who visit female sex workers (FSW). Methods We conducted a case-control study: 106 newly HIV (+) vs. 87 HIV (-) elderly men who visited FSW with similar age, education levels, marital statuses, monthly expenses for entertainment and migration experiences. Experiences of visiting FSW, social interaction, and intimate social support were obtained. Backward binary logistic regression was applied. Results Cases’ first visit to FSW happened at the age of 44.01 ± 12.25, older than controls (33.90 ± 13.43). 23.58% cases had gotten HIV-related health education (HRHE) before, less than controls (57.47%). More cases (48.91%) “always” got material support than controls (34.25%). Less cases gave “close” (38.04%) comments toward daily life, “satisfied” (34.78%) with their sexual life, “agree” being emotional fulfilled (46.74%) than controls (71.23% ,64.38%, and 61.64%). Risky factors for HIV infection among elderly men were having 3000 YUAN and above monthly income, visiting teahouse with friends, living without spouses, visiting different FSW, visiting FSW for other reason, receiving material support from most intimate sexual partner, older age of first visit to FSW. The protective factors were receiving HRHE, visiting FSW due to loneliness, and giving positive comments toward daily life with most intimate sexual partner. Conclusions Elderly men’s social interactions are mainly visiting teahouse which is a potential sexual venue. Getting HRHE is formal protective social interactions but very rare for cases (23.58%). Social support from sexual partner is not enough. Emotional support is protective meanwhile material support only is risky for becoming HIV-positive. …

Several mechanisms including reduced CCR5 expression, protective HLA, viral restriction factors, broadly neutralizing antibodies, and more efficient T-cell responses, have been reported to account for HIV cont...

AbstractBackgroundThis study examined the effects of HIV on resting state functional connectivity (RSFC) in a large cohort of people living with HIV (PWH) and healthy controls without HIV (PWoH). Within PWH analyses focused on the effects of viral suppression and cognitive impairment on RSFC.MethodsA total of 316 PWH on stable combination antiretroviral therapy and 209 demographically matched PWoH were scanned at a single institution. Effects of the virus were examined by grouping PWH by detectable (viral load > 20 copies/ml; VLD) and undetectable (VLU) viral loads and as being cognitively impaired (CI) (Global Deficit Score ≥ 0.5) or cognitively normal (CN). Regression analysis, Object Oriented Data Analysis, and spring embedded graph models were applied to RSFC measures from 298 established brain ROIs comprising 13 brain networks to examine group differences.ResultsNo significant RSFC differences were observed between PWH and PWoH. Within PWH, there were no significant differences in RSFC between VLD and VLU subgroups and CI and CN subgroups.ConclusionThere were no significant effects of HIV on RSFC in our relatively large cohort of PWH and PWoH. Future studies could increase the sample size and combine with other imaging modalities.

AbstractBackgroundBone mineral density (BMD) loss may be accelerated in people with HIV (PLWH). It is unknown whether an individual polygenic risk score (PRS) is associated with low BMD in PLWH.MethodsWe included Swiss HIV Cohort Study participants of self-reported European descent, each with >2 per-protocol Dual X-ray Absorptiometry (DXA) measurements >2 years apart (2011-2020). We obtained uni-/multivariable odds ratios (OR) for DXA-defined osteoporosis based on traditional and HIV-related osteoporosis risk factors and a genome-wide PRS built from 9413 single nucleotide polymorphisms associated with low BMD in the general population. Controls were free from osteoporosis/osteopenia on all DXA measurements.ResultsWe included 438 participants (149 with osteoporosis, 289 controls; median age, 53 years, 82% male, 95% with suppressed HIV RNA). Participants with unfavorable osteoporosis-PRS (top vs. bottom PRS quintile) had univariable and multivariable-adjusted osteoporosis OR=4.76 (95% confidence interval [CI], 2.34-9.67) and 4.13 (1.86-9.18), respectively. For comparison, hepatitis C seropositivity, 5-year tenofovir disoproxil fumarate exposure, and parent history of hip fracture had univariable osteoporosis-OR=2.26 (1.37-3.74), 1.84 (1.40-2.43), and 1.54 (0.82-2.9), respectively.ConclusionsIn PLWH in Switzerland, osteoporosis was independently associated with a BMD-associated PRS, after adjustment for established osteoporosis risk factors including exposure to tenofovir DF.

Abstract Objectives To make clear the roles of social interaction and social support in HIV infection among elderly men who visit female sex workers (FSW). Methods We conducted a case-control study: 106 newly HIV (+) vs. 87 HIV (-) elderly men who visited FSW with similar age, education levels, marital statuses, monthly expenses for entertainment and migration experiences. Experiences of visiting FSW, social interaction, and intimate social support were obtained. Backward binary logistic regression was applied. Results Cases’ first visit to FSW happened at the age of 44.01 ± 12.25, older than controls (33.90 ± 13.43). 23.58% cases had gotten HIV-related health education (HRHE) before, less than controls (57.47%). More cases (48.91%) “always” got material support than controls (34.25%). Less cases gave “close” (38.04%) comments toward daily life, “satisfied” (34.78%) with their sexual life, “agree” being emotional fulfilled (46.74%) than controls (71.23% ,64.38%, and 61.64%). Risky factors for HIV infection among elderly men were having 3000 YUAN and above monthly income, visiting teahouse with friends, living without spouses, visiting different FSW, visiting FSW for other reason, receiving material support from most intimate sexual partner, older age of first visit to FSW. The protective factors were receiving HRHE, visiting FSW due to loneliness, and giving positive comments toward daily life with most intimate sexual partner. Conclusions Elderly men’s social interactions are mainly visiting teahouse which is a potential sexual venue. Getting HRHE is formal protective social interactions but very rare for cases (23.58%). Social support from sexual partner is not enough. Emotional support is protective meanwhile material support only is risky for becoming HIV-positive. …

Clusters of cases of pneumocystis pneumonia and Kaposi’s sarcoma in New York and California in men who had sex with men were early harbingers of the acquired immunodeficiency syndrome (AIDS) epidemic. The syndrome was also soon noted to be associated with a high incidence of aggressive B-cell lymphomas. As the AIDS definition crystallized, Kaposi’s sarcoma, aggressive B-cell lymphomas, and invasive cervical cancer were considered to be AIDS-defining cancers when they developed in patients with human immunodeficiency virus (HIV) infection. Additional cancers are now known to be associated with HIV (Table 1). The term HIV-associated cancer is used here to describe this larger group of cancers (both AIDS-defining and non–AIDS-defining cancers) that have an increased incidence among patients with HIV infection. In addition, incidental cancers also may develop in patients with HIV infection.

Randomized-trial data on the risks and benefits of antiretroviral therapy (ART) as compared with zidovudine and single-dose nevirapine to prevent transmission of the human immunodeficiency virus (HIV) in HIV-infected pregnant women with high CD4 counts are lacking.

Data from randomized trials are lacking on the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic human immunodeficiency virus (HIV) infection who have a CD4+ count of more than 350 cells per cubic millimeter.

Progressive immune dysfunction and the acquired immunodeficiency syndrome (AIDS) develop in most persons with untreated infection with human immunodeficiency virus type 1 (HIV-1) but in only approximately 20 to 30% of persons infected with HIV type 2 (HIV-2); among persons infected with both types, the natural history of disease progression is poorly understood.

Antiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations.

The optimal time for the initiation of antiretroviral therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection is uncertain.

There is considerable genetic diversity among viruses of different subtypes (designated A to J) in the major group of human immunodeficiency virus type 1 (HIV-1), the form of HIV that is dominant in the global epidemic. If available, HIV-1 sequences pre-dating the recognition of AIDS could be crucial in defining the time of origin and the subsequent evolution of these viruses in humans. The oldest known case of HIV-1 infection was reported to be that of a sailor from Manchester who died of an AIDS-like illness in 1959; however, the authenticity of this case has not been confirmed. Genetic analysis of sequences from clinical materials obtained from 1971 to 1976 from members of a Norwegian family infected earlier than 1971 showed that they carried viruses of the HIV-1 outlier group, a variant form that is mainly restricted to West Africa. Here we report the amplification and characterization of viral sequences from a 1959 African plasma sample that was previously found to be HIV-1 seropositive. Multiple phylogenetic analyses not only authenticate this case as the oldest known HIV-1 infection, but also place its viral sequence near the ancestral node of subtypes B and D in the major group, indicating that these HIV-1 subtypes, and perhaps all major-group viruses, may have evolved from a single introduction into the African population not long before 1959.

A retrovirus belonging to the family of recently discovered human T-cell leukemia viruses (HTLV), but clearly distinct from each previous isolate, has been isolated from a Caucasian patient with signs and symptoms that often precede the acquired immune deficiency syndrome (AIDS). This virus is a typical type-C RNA tumor virus, buds from the cell membrane, prefers magnesium for reverse transcriptase activity, and has an internal antigen (p25) similar to HTLV p24. Antibodies from serum of this patient react with proteins from viruses of the HTLV-I subgroup, but type-specific antisera to HTLV-I do not precipitate proteins of the new isolate. The virus from this patient has been transmitted into cord blood lymphocytes, and the virus produced by these cells is similar to the original isolate. From these studies it is concluded that this virus as well as the previous HTLV isolates belong to a general family of T-lymphotropic retroviruses that are horizontally transmitted in humans and may be involved in several pathological syndromes, including AIDS.