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Tropical Medicine &International Health, EarlyView.

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

AbstractBackgroundIt is unclear whether the reporting quality of antiretroviral non-inferiority randomised controlled trials (ARV NI-RCTs) has improved since the CONSORT guideline release in 2006. The primary objective of this systematic review was assessing the methodological and reporting quality of ARV NI-RCTs. We also assessed reporting quality by funding source and publication year.MethodsWe searched Medline, Embase, and Cochrane Central from inception to 14 November 2022. We included NI-RCTs comparing ≥2 antiretroviral regimens used for HIV treatment or prophylaxis. We used the Cochrane Risk of Bias 2.0 (RoB 2.0) tool to assess risk of bias. Screening and data extraction were performed blinded and in duplicate. Descriptive statistics were used to summarise data; statistical tests were two-sided, with significance defined as p

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.

For nearly 40 years, the US Preventive Services Task Force (USPSTF) has issued evidence-based recommendations about clinical preventive services in the interest of health promotion and disease prevention for the US. The USPSTF was first convened in 1984 by the US Department of Health and Human Services (HHS), in part to address concerns that few clinicians were focused on interventions related to prevention because of lack of clarity on the evidence base for the effectiveness of these interventions. The USPSTF regularly issues recommendations on a variety of important preventive health services based on an explicit evidence-based approach that includes input from relevant stakeholders and opportunity for public comment. These recommendation statements and the evidence reports on which they are based are posted on the USPSTF website and published in JAMA with commentary in the journals across the JAMA Network and broadly available to clinicians, patients, and the public. Exemplary topics covered by the recommendations range from cancer screening (eg, breast, colon, prostate), screening for osteoporosis, the use of aspirin for the prevention of cardiovascular disease, and preexposure prophylaxis (PrEP) for the prevention of HIV, among many others.

This Viewpoint examines the recent decision by a federal district court that undercuts the Affordable Care Act’s mandate for cost-free coverage of preventive services, including contraception, some vaccinations, many screenings, and preexposure prophylaxis for HIV, among others.

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.

AbstractBackgroundTuberculosis infection (TBI) and tuberculosis disease (TBD) incidence remains poorly described following household contact (HHC) rifampin-/multidrug-resistant tuberculosis exposure. We sought to characterize TBI and TBD incidence at one-year in HHCs and to evaluate tuberculosis preventive therapy (TPT) use in high-risk groups.MethodsWe previously conducted a cross-sectional study of HHCs of rifampin-/multidrug-resistant tuberculosis in 8 high-burden countries and re-assessed TBI (interferon-gamma release assay, HHCs ≥5 years) and TBD (HHCs all ages) at one-year. Incidence was estimated across age and risk groups (age

by Joyce Gyamfi, Juliet Iwelunmor, Shivani Patel, Vilma Irazola, Angela Aifah, Ashlin Rakhra, Mark Butler, Rajesh Vedanthan, Giang Nguyen Hoang, Monicah Nyambura, Hoa Nguyen, Cuc Nguyen, Kwaku Poku Asante, Solomon Nyame, Kwame Adjei, John Amoah, Kingsley Apusiga, Kezia Gladys Amaning Adjei, Manuel Ramierz-Zea, Diego Hernandez, Meredith Fort, Hanspria Sharma, Prashant Jarhyan, Emmanuel Peprah, Gbenga Ogedegbe Guidance on contextually tailored implementation strategies for the prevention, treatment, and control of hypertension is limited in lower-middle income countries (Lower-MIC). To address this limitation, we compiled implementation strategies and accompanying outcomes of evidence-based hypertension interventions currently being implemented in five Lower-MIC. The Global Research on Implementation and Translation Science (GRIT) Coordinating Center (CC) (GRIT-CC) engaged its global network sites at Ghana, Guatemala, India, Kenya, and Vietnam. Purposively sampled implementation science experts completed an electronic survey assessing implementation outcomes, in addition to implementation strategies used in their ongoing hypertension interventions from among 73 strategies within the Expert Recommendations for Implementing Change (ERIC). Experts rated the strategies based on highest priority to their interventions. We analyzed the data by sorting implementation strategies utilized by sites into one of the nine domains in ERIC and summarized the data using frequencies, proportions, and means. Seventeen implementation experts (52.9% men) participated in the exercise. Of Proctor’s implementation outcomes identified across sites, all outcomes except for appropriateness were broadly assessed by three or more countries. Overall, 59 out of 73 (81%) strategies were being utilized in the five countries. The highest priority implementation strategies utilized across all five countries focused on evaluative and iterative strategies (e.g., identification of context specific barriers and facilitators) to delivery of patient- and community-level interventions, while the lowest priority was use of financial and infrastructure change strategies. More capacity building strategies (developing stakeholder interrelationships, training and educating stakeholders, and supporting clinicians) were incorporated into interventions implemented in India and Vietnam than Ghana, Kenya, and Guatemala. Although robust implementation strategies are being used in Lower -MICs, there is minimum use of financial and infrastructure change strategies. Our study contributes to the growing literature that demonstrates the use of Expert Recommendations for Implementing Change (ERIC) implementation strategies to deliver evidence-based hypertension interventions in Lower-MICs and will inform future cross-country data harmonization activities in resource-constrained settings.

by Valerian Mwenda, Joan-Paula Bor, Mary Nyangasi, James Njeru, Sharon Olwande, Patricia Njiri, Marc Arbyn, Steven Weyers, Philippe Tummers, Marleen Temmerman Background Globally, cervical cancer is a major public health problem, with about 604,000 new cases and over 340,000 deaths in 2020. In Kenya, it is the leading cause of cancer deaths, with over 3,000 women dying in 2020 alone. Both the Kenyan cancer screening guidelines and the World Health Organization’s Global Cervical Cancer Elimination Strategy recommend human papillomavirus (HPV) testing as the primary screening test. However, HPV testing is not widely available in the public healthcare system in Kenya. We conducted a pilot study using a point of care (POC) HPV test to inform national roll-out. Methods The pilot was implemented from October 2019 to December 2020, in nine health facilities across six counties. We utilized the GeneXpert platform (Cepheid, Sunnyvale, CA, USA), currently used for TB, Viral load testing and early infant diagnosis for HIV, for HPV screening. Visual inspection with acetic acid (VIA) was used for triage of HPV-positive women, as recommended in national guidelines. Quality assurance (QA) was performed by the National Oncology Reference Laboratory (NORL), using the COBAS 4800 platform (Roche Molecular System, Pleasanton, CF, USA). HPV testing was done using either self or clinician-collected samples. We assessed the following screening performance indicators: screening coverage, screen test positivity, triage compliance, triage positivity and treatment compliance. Test agreement between local GeneXpert and central comparator high-risk HPV (hrHPV) testing for a random set of specimens was calculated as overall concordance and kappa value. We conducted a final evaluation and applied the Nominal Group Technique (NGT) to identify implementation challenges and opportunities. Key findings The screening coverage of target population was 27.0% (4500/16,666); 52.8% (2376/4500) were between 30–49 years of age. HPV positivity rate was 22.8% (1027/4500). Only 10% (105/1027) of HPV positive cases were triaged with VIA/VILI; 21% (22/105) tested VIA/VILI positive, and 73% (16/22) received treatment (15 received cryotherapy, 1 was referred for biopsy). The median HPV testing turnaround time (TAT) was 24 hours (IQR 2–48 hours). Invalid sample rate was 2.0% (91/4500). Concordance between the Cepheid and COBAS was 86.2% (kappa value = 0.71). Of 1042 healthcare workers, only 5.6% (58/1042) were trained in cervical cancer screening and treatment, and only 69% (40/58) of those trained were stationed at service provision areas. Testing capacity was identifed as the main challenge, while the community strategy was the main opportunity. Conclusion HPV testing can be performed on GeneXpert as a near point of care platform. However, triage compliance and testing TAT were major concerns. We recommend strengthening of the screening-triage-treatment cascade and expansion of testing capacity, before adoption of a GeneXpert-based HPV screening among other near point of care platforms in Kenya. …

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. …

Abstract Background Since January 2017, the recommended first-line antiretroviral regimen in Brazil is the fixed-dose combination of tenofovir plus lamivudine with dolutegravir (TL + D). According to the literature, integrase resistance-associated mutations (INRAMs) are rarely found upon virologic failure to first-line dolutegravir plus two nucleoside reverse transcriptase inhibitors. We evaluated the HIV antiretroviral genotypic resistance profile of patients referred for genotyping in the public health system who failed first-line TL + D after at least six months of therapy on or before December 31, 2018. Methods HIV Sanger sequences of the pol gene were generated from plasma of patients with confirmed virologic failure to first-line TL + D in the Brazilian public health system before December 31, 2018. Results One hundred thirteen individuals were included in the analysis. Major INRAMs were detected in seven patients (6.19%), four with R263K, one with G118R, one with E138A, and one with G140R. Four patients with major INRAMs also had the K70E and M184V mutations in the RT gene. Sixteen (14.2%) additional individuals presented minor INRAMs, and five (4,42%) patients had both major and minor INRAMS. Thirteen (11.5%) patients also presented mutations in the RT gene selected by tenofovir and lamivudine, including four with both the K70E and M184V mutations and four with only M184V. The integrase mutations L101I and T124A, which are in the in vitro pathway for integrase inhibitor resistance, were found in 48 and 19 patients, respectively. Mutations not related to TL + D, thus probable transmitted resistance mutations (TDR), were present in 28 patients (24.8%): 25 (22.1%) to nucleoside reverse transcriptase inhibitors, 19 (16.8%) to non-nucleoside reverse transcriptase inhibitors, and 6 (5.31%) to protease inhibitors. Conclusions In marked contrast to previous reports, we report a relatively high frequency of INRAMs among selected patients failing first-line TL + D in the public health system in Brazil. Possible reasons for this discrepancy include delays in detecting virologic failure, patients inadvertently on dolutegravir monotherapy, TDR, and/or infecting subtype. …

Abstract Introduction HIV epidemics in Western and Central Africa (WCA) remain concentrated among key populations, who are often unaware of their status. HIV self-testing (HIVST) and its secondary distribution among key populations, and their partners and relatives, could reduce gaps in diagnosis coverage. We aimed to document and understand secondary HIVST distribution practices by men who have sex with men (MSM), female sex workers (FSW), people who use drugs (PWUD); and the use of HIVST by their networks in Côte d’Ivoire, Mali, and Senegal. Methods A qualitative study was conducted in 2021 involving (a) face-to-face interviews with MSM, FSW, and PWUD who received HIVST kits from peer educators (primary users) and (b) telephone interviews with people who received kits from primary contacts (secondary users). These individual interviews were audio-recorded, transcribed, and coded using Dedoose software. Thematic analysis was performed. Results A total of 89 participants, including 65 primary users and 24 secondary users were interviewed. Results showed that HIVST were effectively redistributed through peers and key populations networks. The main reported motivations for HIVST distribution included allowing others to access testing and protecting oneself by verifying the status of partners/clients. The main barrier to distribution was the fear of sexual partners’ reactions. Findings suggest that members of key populations raised awareness of HIVST and referred those in need of HIVST to peer educators. One FSW reported physical abuse. Secondary users generally completed HIVST within two days of receiving the kit. The test was used half the times in the physical presence of another person, partly for psychological support need. Users who reported a reactive test sought confirmatory testing and were linked to care. Some participants mentioned difficulties in collecting the biological sample (2 participants) and interpreting the result (4 participants). Conclusion The redistribution of HIVST was common among key populations, with minor negative attitudes. Users encountered few difficulties using the kits. Reactive test cases were generally confirmed. These secondary distribution practices support the deployment of HIVST to key populations, their partners, and other relatives. In similar WCA countries, members of key populations can assist in the distribution of HIVST, contributing to closing HIV diagnosis gaps. …

Objectives: We investigated occurrence of and risk factors for severe COVID-19 outcomes in PWH in the Netherlands. Design: Ongoing prospective nationwide HIV cohort study. Methods: COVID-19 diagnoses and outcomes with other relevant medical information were prospectively collected from electronic medical records in all HIV treatment centers in the Netherlands, from the start of the COVID-19 epidemic until 31 December 2021. Risk factors for COVID-19 related hospitalization and death were investigated using multivariable logistic regression, including demographics, HIV-related factors, and comorbidities. Results: The cohort comprises 21,289 adult PWH, median age 51.2 years, 82% male, 70% were of Western origin, 12.0% were of sub-Saharan African and 12.6% Latin American / Caribbean origin, 96.8% had HIV-RNA…

Objective: To describe pubertal growth spurts among adolescents living with perinatally-acquired HIV (ALWPHIV) on antiretroviral therapy (ART). Design: Observational data collected from 1994–2015 in the CIPHER global cohort collaboration. Methods: ALWPHIV who initiated ART age…

No abstract available…

Objectives: To identify types, evidence, and study gaps of alternative HIV preexposure prophylaxis (PrEP) care delivery models in the published literature. Design: Systematic review and narrative synthesis Methods: We searched in the US Centers for Disease Control and Prevention (CDC) Prevention Research Synthesis (PRS) database through December 2022 (PROSPERO CRD42022311747). We included studies published in English that reported implementation of alternative PrEP care delivery models. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using the adapted Newcastle-Ottawa Quality Assessment Scale. Those that met our study criteria were evaluated for efficacy against CDC Evidence-Based Intervention (EBI) or Evidence-Informed Intervention (EI) criteria or Health Resources and Services Administration Emergency Strategy (ES) criteria, or for applicability by using an assessment based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: This review identified 16 studies published between 2018-2022 that implemented alternative prescriber (n = 8), alternative setting for care (n = 4), alternative setting for laboratory screening (n = 1), or a combination of the above (n = 3) . The majority of studies were US-based (n = 12) with low risk of bias (n = 11). None of the identified studies met EBI, EI, or ES criteria. Promising applicability was found for pharmacists prescribers, telePrEP , and mail-in testing. Conclusions: Delivery of PrEP services outside of the traditional care system by expanding providers of PrEP care (e.g., pharmacist prescribers), as well as the settings of PrEP care (i.e., telePrEP) and laboratory screening (i.e., mail-in testing) may increase PrEP access and care delivery. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Objective: The perturbation of tryptophan (TRP) metabolism has been linked with HIV infection and cardiovascular disease (CVD), but the interrelationship among TRP metabolites, gut microbiota, and atherosclerosis remain unclear in the context of HIV infection. Methods: We included 361 women (241 HIV+, 120 HIV-) with carotid artery plaque assessments from the Women\'s Interagency HIV Study, measured ten plasma TRP metabolites and profiled fecal gut microbiome. TRP metabolites-related gut bacteria were selected through the Analysis of Compositions of Microbiomes with Bias Correction method. Associations of TRP metabolites and related microbial features with plaque were examined using multivariable logistic regression. Results: While plasma kynurenic acid (KYNA) (odds ratio [OR] = 1.93, 95% confidence interval [CI]:1.12, 3.32 per one SD increase; P = 0.02) and KYNA/TRP (OR = 1.83 [95%CI:1.08, 3.09], P = 0.02) were positively associated with plaque, indole-3-propionate (IPA) (OR = 0.62 [95%CI:0.40, 0.98], P = 0.03) and IPA/KYNA (OR = 0.51[95%CI:0.33, 0.80], P …

Objective: Our study aimed to assess the impact of pharmacogenomic panel testing in persons living with HIV (PWH). Design: Prospective, observational intervention assessment Methods: One hundred PWH were provided a comprehensive pharmacogenomic panel during routine care visits within the HIV specialty clinic of a large academic medical center. The panel determined the presence of specific genetic variants that could predict response or toxicity to commonly prescribed antiretroviral therapy (ART) and non-ART medications. An HIV specialty pharmacist reviewed the results with participants and the care team. The pharmacist (1) recommended clinically actionable interventions based on the participants current drug therapy, (2) assessed for genetic explanations for prior medication failures, adverse effects, or intolerances, and (3) advised on potential future clinically actionable care interventions based on individual genetic phenotypes. Results: Ninety-six participants (median age 53y, 74% white, 84% male, 89% viral load…

Background: Infancy is an important developmental period when the microbiome is shaped. We hypothesized that earlier antiretroviral therapy (ART) initiation would attenuate HIV effects on microbiota in the mouth. Methods: Oral swabs were collected from 477 children living with HIV (CLWH) and 123 children without (controls) at two sites in Johannesburg, South Africa. CLWH had started ART…

Background: Data supporting dementia as a risk factor for COVID-19 mortality relied on ICD-10 codes, yet nearly 40% of individuals with probable dementia lack a formal diagnosis. Dementia coding is not well-established for people with HIV (PWH), and its reliance may affect risk assessment. Methods: This retrospective cohort analysis of PWH with SARS-CoV-2 polymerase chain reaction positivity includes comparisons to people without HIV (PWoH), matched by age, sex, race, and zipcode. Primary exposures were dementia diagnosis, by ICD-10 codes, and cognitive concerns, defined as possible cognitive impairment up to 12 months before COVID-19 diagnosis after clinical review of notes from the electronic health record. Logistic regression models assessed the effect of dementia and cognitive concerns on odds of death (OR [95% confidence interval]); models adjusted for VACS Index 2.0. Results: Sixty-four PWH were identified out of 14,129 patients with SARS-CoV-2 infection and matched to 463 PWoH. Compared to PWoH, PWH had a higher prevalence of dementia (15.6% vs. 6%, p = 0.01) and cognitive concerns (21.9% vs. 15.8%, p = 0.04). Death was more frequent in PWH (p …

Objective: Hepatitis C Virus (HCV) co-infection is associated with increased morbidity and mortality in people with HIV (PWH). Sustained virological response (SVR) decreases the risk of HCV-associated morbidity. We compared mortality, risk of AIDS-defining events, and non-AIDS non-liver (NANL) cancers between HCV co-infected PWH who reached SVR and mono-infected PWH. Design: Adult PWH from 21 cohorts in Europe and North America that collected HCV treatment data were eligible if they were HCV-free at time of ART initiation. Methods: Up to 10 mono-infected PWH were matched (on age, sex, date of ART start, HIV acquisition route, and being followed at the time of SVR) to each HCV co-infected PWH who reached SVR. Cox models were used to estimate relative hazards (HR) of all-cause mortality, AIDS-defining events, and NANL cancers after adjustment. Results: Among 62,495 PWH, 2,756 acquired HCV, of whom 649 reached SVR. For 582 of these, ≥1 mono-infected PWH could be matched, producing a total of 5,062 mono-infected PWH. The estimated HRs comparing HCV co-infected PWH who reached SVR with mono-infected PWH were 0.29 [95%CI 0.12–0.73] for mortality, 0.85 [0.42–1.74] for AIDS-defining events, and 1.21 [0.86–1.72] for NANL cancer. Conclusion: PWH who reached SVR a short time after HCV acquisition were not at higher risk of overall mortality compared to mono-infected PWH. However, the apparent higher risk of NANL cancers in HCV co-infected PWH who reached SVR after a DAA-based treatment compared to mono-infected PWH, though compatible with a null association, suggests a need for monitoring of those events following SVR. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Objective: Immune responses to SARS-CoV-2 mRNA vaccines in people living with HIV (PLWH) with a history of late presentation (LP) and their durability have not been fully characterized. Design: In this prospective, longitudinal study, we sought to assess T-cell and humoral responses to SARS-CoV-2 mRNA vaccination up to 6 months in LP-PLWH on effective combination antiretroviral therapy (cART) as compared to HIV-negative healthcare workers (HCWs), and to evaluate whether previous SARS-CoV-2 infection modulates immune responses to vaccine. Methods: SARS-CoV-2 Spike (S)–specific T-cell responses were determined by two complementary flow cytometry methodologies, i.e. activation-induced marker (AIM) assay and intracellular cytokine staining (ICS), while humoral responses were measured by ELISA (anti-RBD antibodies) and receptor-binding inhibition assay (Spike-ACE2 binding inhibition activity), before vaccination (T0), 1 month (T1) and 5 months (T2) after the second dose. Results: LP-PLWH showed at T1 and T2 significant increase of: S-specific memory and circulating T follicular helper (cTfh) CD4 T-cells; polyfunctional Th1-cytokine (IFN-γ, TNF-α, IL-2)- and Th2-cytokine (IL-4)-producing S-specific CD4 T-cells; anti-RBD antibodies and Spike-ACE2 binding inhibition activity. Immune responses to vaccine in LP-PLWH were not inferior to HCWs overall, yet S-specific CD8 T-cells and Spike-ACE2 binding inhibition activity correlated negatively with markers of immune recovery on cART. Interestingly, natural SARS-CoV-2 infection, while able to sustain S-specific antibody response, seems less efficacious in inducing a T-cell memory and in boosting immune responses to vaccine, possibly reflecting an enduring partial immunodeficiency. Conclusions: Altogether, these findings support the need for additional vaccine doses in PLWH with a history of advanced immune depression and poor immune recovery on effective cART. Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

Background: The protective advantage against atherosclerotic cardiovascular disease (ASCVD) experienced by women compared to men in the general population is diminished in some high- risk populations. People living with HIV have a higher risk for ASCVD compared to the general population. Objective: Compare the incidence of ASCVD among women versus men living with HIV. Methods: We analyzed data from women (n = 17,118) versus men (n = 88,840) with HIV, and women (n = 68,472) and men (n = 355,360) matched on age, sex, and calendar year of enrollment without HIV who had commercial health insurance in the MarketScan database between 2011 and 2019. ASCVD events during follow-up, including myocardial infarction, stroke, and lower- extremity artery disease, were identified using validated claims-based algorithms. Results: Among those with and without HIV, the majority of women (81.7%) and men (83.6%) were…

Objectives: Ablative electrocautery is effective treating anal high-grade squamous intraepithelial lesions (HSIL). However, persistence or recurrence of the HSIL despite ablative sessions is not uncommon. The aim of this study is to assess the feasibility of topical cidofovir as salvage therapy for the management of refractory HSIL Design: A prospective un-controlled unicenter study of men and transgender people who have sex with men with HIV who had a refractory intra-anal HSIL after ablative treatments and who received topical cidofovir (ointment at 1%, auto-applicated, three times a week, a total of 8 weeks) as salvage therapy. Effectiveness was evaluated on-treatment defining response as resolution or regression to low-grade lesion of HSIL in the biopsy post-treatment. Tolerance and recurrences were recorded. Results: From 2017 to 2022, 23 patients with refractory intra-anal HSIL (78.3% persistent lesions, 39% affecting > 50% of circumference and a median of 6 previous ablative sessions) were treated with topical cidofovir. A response was observed in 16 of 23 patients (69.5% [95% CI; 50.8–88.4]). Local tolerance was reported as regular or bad in 13 patients (52.2%), requiring modification of the treatment in 8 patients (3 early discontinuation and 5 dose reduction). Non serious side-effects were reported. After a median follow-up of 30.3 months, 2 of the 16 patients with a response developed recurrent HSIL (Recurrence rate, 25.4% at 12 months [95% CI, 0–35]). Conclusions: Topical cidofovir could be a good option in the management of anal HSIL due to its good effectiveness, low recurrence rate, and acceptable tolerance even in difficult-to-treat lesions. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Abstract Introduction Objectives of this study, as part of a nation-wide HIV pre-exposure prophylaxis (PrEP) evaluation project, were to determine the incidence of infections with HIV, chlamydia, gonorrhea, syphilis, hepatitis A/B/C in persons using PrEP, and to describe the health care funded PrEP use in Germany. Additionally, factors associated with chlamydia/gonorrhea and syphilis infections were assessed. Methods Anonymous data of PrEP users were collected at 47 HIV-specialty centers from 09/2019–12/2020. Incidence rates were calculated per 100 person years (py). Using longitudinal mixed models, we analyzed risk factors associated with sexually transmitted infections (STIs). Results 4620 PrEP users were included: 99.2% male, median age 38 years (IQR 32–45), 98.6% men who have sex with men (MSM). The median duration of PrEP exposure was 451 days (IQR 357–488), totaling 5132 py. Four HIV infections were diagnosed, incidence rate 0,078/100py (95% CI 0.029–0.208). For two, suboptimal adherence was reported and in the third case, suboptimal adherence and resistance to emtricitabine were observed. One infection was likely acquired before PrEP start. Incidence rates were 21.6/100py for chlamydia, 23.7/100py for gonorrhea, 10.1/100py for syphilis and 55.4/100py for any STI and decreased significantly during the observation period. 65.5% of syphilis, 55.6% of chlamydia and 50.1% of gonorrhea cases were detected by screening of asymptomatic individuals. In a multivariable analysis among MSM younger age, PrEP start before health insurance coverage and daily PrEP were associated with greater risk for chlamydia/gonorrhea. Symptom triggered testing and a history of STI were associated with a higher risk for chlamydia/gonorrhea and syphilis. A significantly lower risk for chlamydia/gonorrhea and syphilis was found for observations during the COVID-19 pandemic period. Conclusions We found that HIV-PrEP is almost exclusively used by MSM in Germany. A very low incidence of HIV infection and decreasing incidence rates of STIs were found in this cohort of PrEP users. The results were influenced by the SARS-CoV-2 pandemic. Rollout of PrEP covered by health insurance should be continued to prevent HIV infections. Increased PrEP availability to people at risk of HIV infection through the elimination of barriers requires further attention. Investigation and monitoring with a longer follow-up would be of value. …

Abstract Background Since January 2017, the recommended first-line antiretroviral regimen in Brazil is the fixed-dose combination of tenofovir plus lamivudine with dolutegravir (TL + D). According to the literature, integrase resistance-associated mutations (INRAMs) are rarely found upon virologic failure to first-line dolutegravir plus two nucleoside reverse transcriptase inhibitors. We evaluated the HIV antiretroviral genotypic resistance profile of patients referred for genotyping in the public health system who failed first-line TL + D after at least six months of therapy on or before December 31, 2018. Methods HIV Sanger sequences of the pol gene were generated from plasma of patients with confirmed virologic failure to first-line TL + D in the Brazilian public health system before December 31, 2018. Results One hundred thirteen individuals were included in the analysis. Major INRAMs were detected in seven patients (6.19%), four with R263K, one with G118R, one with E138A, and one with G140R. Four patients with major INRAMs also had the K70E and M184V mutations in the RT gene. Sixteen (14.2%) additional individuals presented minor INRAMs, and five (4,42%) patients had both major and minor INRAMS. Thirteen (11.5%) patients also presented mutations in the RT gene selected by tenofovir and lamivudine, including four with both the K70E and M184V mutations and four with only M184V. The integrase mutations L101I and T124A, which are in the in vitro pathway for integrase inhibitor resistance, were found in 48 and 19 patients, respectively. Mutations not related to TL + D, thus probable transmitted resistance mutations (TDR), were present in 28 patients (24.8%): 25 (22.1%) to nucleoside reverse transcriptase inhibitors, 19 (16.8%) to non-nucleoside reverse transcriptase inhibitors, and 6 (5.31%) to protease inhibitors. Conclusions In marked contrast to previous reports, we report a relatively high frequency of INRAMs among selected patients failing first-line TL + D in the public health system in Brazil. Possible reasons for this discrepancy include delays in detecting virologic failure, patients inadvertently on dolutegravir monotherapy, TDR, and/or infecting subtype. …

Abstract Introduction HIV epidemics in Western and Central Africa (WCA) remain concentrated among key populations, who are often unaware of their status. HIV self-testing (HIVST) and its secondary distribution among key populations, and their partners and relatives, could reduce gaps in diagnosis coverage. We aimed to document and understand secondary HIVST distribution practices by men who have sex with men (MSM), female sex workers (FSW), people who use drugs (PWUD); and the use of HIVST by their networks in Côte d’Ivoire, Mali, and Senegal. Methods A qualitative study was conducted in 2021 involving (a) face-to-face interviews with MSM, FSW, and PWUD who received HIVST kits from peer educators (primary users) and (b) telephone interviews with people who received kits from primary contacts (secondary users). These individual interviews were audio-recorded, transcribed, and coded using Dedoose software. Thematic analysis was performed. Results A total of 89 participants, including 65 primary users and 24 secondary users were interviewed. Results showed that HIVST were effectively redistributed through peers and key populations networks. The main reported motivations for HIVST distribution included allowing others to access testing and protecting oneself by verifying the status of partners/clients. The main barrier to distribution was the fear of sexual partners’ reactions. Findings suggest that members of key populations raised awareness of HIVST and referred those in need of HIVST to peer educators. One FSW reported physical abuse. Secondary users generally completed HIVST within two days of receiving the kit. The test was used half the times in the physical presence of another person, partly for psychological support need. Users who reported a reactive test sought confirmatory testing and were linked to care. Some participants mentioned difficulties in collecting the biological sample (2 participants) and interpreting the result (4 participants). Conclusion The redistribution of HIVST was common among key populations, with minor negative attitudes. Users encountered few difficulties using the kits. Reactive test cases were generally confirmed. These secondary distribution practices support the deployment of HIVST to key populations, their partners, and other relatives. In similar WCA countries, members of key populations can assist in the distribution of HIVST, contributing to closing HIV diagnosis gaps. …

by Robert Kairania, Washington Onyango-Ouma, Tom G. Ondicho, Joseph Kagaayi, Godfrey Kigozi Background In sub-Saharan Africa (SSA), disclosure of HIV status to children remains low. Few studies have examined how children navigate and come to terms with their HIV status. The aim of this study was to explore experiences of children about disclosure of their HIV status. Methods Between October 2020 and July 2021, 18 purposively selected children aged between 12–17 whose HIV status had been disclosed to them by their caregivers or healthcare providers (HCPs) were recruited for this study. We conducted 18 in-depth interviews (IDIs) to collect data for this study. Data were analyzed using the semantic thematic analysis approach. Results Primary data obtained through IDIs revealed that disclosure of HIV status to children occurred as a one-time event without pre—disclosure preparatory planning or focused post disclosure follow-up counseling irrespective of the discloser. Post disclosure psycho-social experiences elicited mixed responses. Some children experienced insults and belittlement and stigma and discrimination in the family and community for out-of-school children and at school for school-going children. Positive disclosure experiences involved receiving support to improve ART adherence through constantly being reminded to take their medications timely at the workplace, by supervisors, for working children and by teachers, at school for school-going children. Conclusions This research contributes to knowledge about children’ s experiences of being HIV infected and can specifically be used to improve disclosure strategies. …

by Edwin Eliel Escobar-Guevara, María Esther de Quesada-Martínez, Yhajaira Beatriz Roldán-Dávila, Belkisyolé Alarcón de Noya, Miguel Antonio Alfonzo-Díaz Human immunodeficiency virus-1 (HIV-1) and Toxoplasma gondii can invade the central nervous system and affect its functionality. Advanced HIV-1 infection has been associated with defects in immune response to T. gondii, leading to reactivation of latent infections and development of toxoplasmic encephalitis. This study evaluates relationship between changes in immune response to T. gondii and neurocognitive impairment in HIV-1/T. gondii co-infected patients, across different stages of HIV-1 infection. The study assessed the immune response to T. gondii by measuring cytokine production in response to parasite antigens, and also neurocognitive functions by performing auditory and visual P300 cognitive evoked potentials, short term memory (Sternberg) and executive function tasks (Wisconsin Card Sorting Test-WCST) in 4 groups of individuals: HIV-1/T. gondii co-infected (P2), HIV-1-infected/T. gondii-non-infected (P1), HIV-1-non-infected/T. gondii-infected (C2) and HIV-1-non-infected/T. gondii-non-infected (C1). Patients (P1 and P2) were grouped in early/asymptomatic (P1A and P2A) or late/symptomatic (P1B/C and P2B/C) according to peripheral blood CD4+ T lymphocyte counts (>350 or…

Journal of Medical Virology, Volume 95, Issue 5, May 2023.

ObjectivesThe aim of this study was to examine the odds of readmission and mortality after discharge against medical advice (DAMA) in the Veneto region of Northeast Italy, drawing on data from the regional archives of emergency department records and hospital discharge records. DesignA retrospective cohort study. SettingHospital discharges, Veneto region, Italy. ParticipantsAll patients discharged after being admitted to a public or accredited private hospital between January 2016 and 31 January 2021 in the Veneto region were considered. A total of 3 574 124 index discharges were examined for inclusion in the analysis. Primary and secondary outcome measuresReadmission and overall mortality at 30 days after the index discharge against admission. ResultsIn our cohort, 7.6 of patients left hospital against their doctor’s advice (n=19 272). These DAMA patients were more likely to be younger (mean age: 45.5 vs 55.0), foreign (22.1% vs 9.1%). The adjusted odds of readmission after DAMA was 2.76 (CI 95% 2.62–2.90) at 30 days (9.5% DAMA vs 4.6% not-DAMA), and the highest readmission rate was recorded in the first 24 hours after the index discharge. Mortality was higher for DAMA patients after adjusting for patient-level and hospital-level characteristics (with adjusted ORs of 1.40 for in-hospital mortality and 1.48 for overall mortality). ConclusionsThe present study shows that DAMA patients are more likely to die and to need hospital readmission than patients discharged by their doctors. DAMA patients should be more committed to a proactive and diligent postdischarge care. …

by Lucy Ngaihbanglovi Pachuau, Caterina Tannous, Richard Lalramhluna Chawngthu, Kingsley Emwinyore Agho Aim To estimate the prevalence and associated factors with the human immune-deficiency virus (HIV) among people who inject drugs (PWID) in Mizoram, Northeast India. Methods The data source for the analysis was the 2019–2020 Mizoram State AIDS Control Society (MSACS) survey from 2695 PWID registered for the Targeted Intervention (TI) services. Logistic regression analysis was conducted to examine the factors associated with HIV among PWID after adjusting for sociodemographic characteristics, injection, and sexual behaviours. Results 21.19% of the participants tested positive for HIV and the prevalence of HIV among male and female participants were 19.5% and 38.6%, respectively. Multiple logistic regression analysis revealed that female (AOR 1.74; 95% CI 1.26–2.41), 35 years or older (AOR 1.45; 95% CI 1.06–1.99), married (AOR 1.41; 95% CI1.08–1.83), divorced/separated/widowed (AOR 2.12; 95% CI 1.59–2.82) and sharing of needle/syringe (AOR 1.62; 95% CI 1.30–2.00) were all positively associated with HIV infection. We also found that concomitant alcohol use was reduced by 35% (AOR 0.65; 95% CI 0.51–0.82) among HIV positive PWID, and HIV infection was also reduced by 46% (AOR 0.54; 95% CI 0.44–0.67) among those PWID who use a condom with a regular partner. Conclusion The findings of this study suggested that there is a high prevalence of HIV among PWID with 1 in 5 PWID reported to have HIV. HIV among PWID was significantly higher among those over 35 years of age, females and divorced/separated/widowed participants. Needle/syringe sharing behaviour is an important determinant of HIV infection. The high prevalence of HIV among PWID population is multifactorial. To reduce HIV among PWID in Mizoram, interventions should target those sharing needles/syringes, females, especially those over 35 years of age and unmarried participants. …

Antimicrobial Agents and Chemotherapy, Ahead of Print.