The available estimates of incidence and prevalence of syphilis among MSM in the Mainland China are high. We used Respondent Driven Sampling to recruit MSM in the study population. The participants were followed up to monitor the incidence and change of risk behaviors. A face-to-face interview was used to collect information about high-risk behaviors, demographics and recreational drug use. To test the difference between prevalent and incident cases, two nested matched case control studies were carried out. The cases were the HIV or syphilis positives found at baseline and during follow-up. We used density sampling to sample six controls for each case.
Our results indicate that compared to incident cases, prevalent cases had higher proportion of reported UAI for both HIV and syphilis. Regression analysis indicated that UAI was the main risk factor among HIV prevalent cases but not in HIV incident cases. These differences could possibly be explained by the implementation of the risk reduction interventions. Syphilis was not a risk factor or HIV prevalent cases but were highly associated with HIV incident cases. Tailored interventions addressing UAI and other risk factors can help to reduce the prevalence and incidence of HIV and syphilis.
American Indians suffer a disproportionate burden of sexually transmitted infection, particularly adolescents. Screening access barriers in rural and reservation-based communities necessitate alternatives to clinic-based options.
Self-administered screening for three sexually transmitted infections was piloted among 32 American Indian adolescents aged 18 to 19. Participants self-collected in a private location; specimens were processed by trained, American Indian paraprofessionals and analysis was conducted by an outside laboratory. Participants testing positive were treated by a Public Health Nurse from the Indian Health Service.
Results suggest high overall acceptability: 69% preferred a self-administered method over clinic-based screening, 75% would encourage their friends to use this method and 100% would use it again.
A self-administered screening method has the ability to reach this and other high-risk populations that might not otherwise access screening, with added potential within the Indian Health Services system for uptake and dissemination in rural, reservation communities facing significant screening barriers.
Chlamydia; gonorrhea; North America; screening; trichomoniasis; American Indians
In order to examine the association between HIV/AIDS knowledge and perceptions, and risk intentions and behaviors among adolescents in Goa, India, cross-sectional data from 942 youth were collected and assessed. The prevalence rates in past 6 months for fighting, smoking, drinking, and drug use were 16.5%, 3.8%, 17.8%, and 1.1% respectively; 5.2% acknowledged ever having engaged in sex. Prior risk involvement was significantly correlated with future risk intention (OR: 9.7~19.7), and those involved in one risk behavior were more likely to engage in other risk behaviors (OR: 1.3~23.5). The findings suggest the importance of targeted interventions for youth engaging or intending to engage in risk behaviors and universal interventions regarding basic facts and skills for all youth in Goa.
Risk behaviors; Intention; Perception; Knowledge; HIV/AIDS; Youth; Goa; India
The HIV epidemic in Vietnam is concentrated, with high prevalence estimates among injection drug users and commercial sex workers. Socio-demographics, substance use and clinical correlates of antiretroviral therapy non-adherence were studied in 100 HIV-1 infected drug users (DUs) receiving antiretroviral therapy (ART) for at least 6 months in Hanoi, Vietnam. All study participants were men with a mean age of 29.9 ± 4.9 years. The median duration on ART was 16.2 ± 12.7 months. 83% reported ‘very good’ or ‘perfect’ adherence in the past 30 days on a subjective one–item Likert scale at time of study enrollment. 48% of participants reported drug use within the previous 6 months, with 22% reporting current drug use. Injection drug use with or without non-injection drug use in the past 6 months (95% C.I. 2.19, 1.30-3.69) and years on ART (95% C.I. 1.43, 1.14-1.78) were correlated with suboptimal adherence. These findings support Vietnam’s ongoing scale-up of harm reduction programs for injection drug users and their integration with ART delivery. Moreover, results highlight the need to identify and implement new ways to support high levels of ART adherence as duration on ART increases.
HIV; Vietnam; adherence; substance abuse; injection drug users
Tanzania has high HIV and human herpes virus-8 rates linked to Kaposi’s sarcoma (KS). We conducted a study at the Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania, to examine changes in proportions of KS to all cancers over the period (2006-2011) of increased AIDS management by ART. We included 1504 KS from ORCI and abstracted information regarding age, sex, HIV and TB, ART duration and KS lesions. Male KS patients (59.6%) were older (42.1±11.5 years) than females (40.4%) (36.2± 9.6 years). KS proportions declined from 10.1% in 2003 to 7.4% in 2011. Being female was associated with increased oral and generalized lesions and higher numbers of lesion locations (OR=2.17, CI: 1.35, 3.51; OR=1.49, CI: 1.08, 2.06; OR=1.06, CI: 0.79, 1.41, respectively). TB was associated with oral, generalized and number of lesion locations (OR=2.08, CI: 1.10, 3.93; OR=2.06, CI: 1.28, 3.33; OR=1.88, CI: 1.19, 2.97, respectively). ART duration showed a protective effect with oral, generalized and number of lesion locations (OR=0.55, CI: 0.33, 0.91; OR=0.73, CI: 0.52, 1.01; OR=0.89, CI: 0.67, 1.18, respectively). With increasing number of patients receiving prolonged ART, future studies should investigate long-term effect of ART and tuberculosis in Tanzania and countries with HIV infection.
HIV; Kaposi’s sarcoma; Tanzania; Trend
HIV-infected individuals have poor responses to hepatitis B vaccine and may have decreased durability of post-vaccination immunity. Retrospective chart review was conducted for HIV-1 positive individuals aged ≥18 years who received hepatitis B vaccine at an urban HIV clinic. A total of 309 patients completed three doses and 178 had post-vaccine serology testing after the third dose. In multivariate analysis, time between the third dose and the first post-vaccine serology testing at 180–359 days (OR = 0.077, p = 0.049) and at ≥360 days (OR = 0.065, p = 0.019) were associated with poor vaccine responses. A significant decrease in seropositivity appeared as early as 180 days after the third vaccine dose, suggesting a rapid loss of vaccine-acquired hepatitis B surface antibody in HIV-infected persons. Our findings suggest that hepatitis B surface antibody should be tested at 6 to 12 months after completing primary vaccine series in order to detect early secondary vaccine failure.
Human immunodeficiency virus; viral disease; hepatitis B; vaccination
Anemia accelerates disease progression and increases mortality among HIV-infected individuals. Few studies have characterized this problem in developing countries. Hemoglobin values of adults presenting to an HIV tertiary care center in India between 1996 and 2007 were collected (n=6996). Multivariate logistic regression analysis was performed to examine associations among anemia, HIV progression, and co-morbidities. Overall anemia prevalence was 41%. Twenty percent of patients with CD4 counts >500 cells/µL were anemic, compared to 64% of those with CD4 counts <100 cells/µL (p<0.001). In multivariate analysis, CD4 count <100 cells/µL (OR:5.0, CI:4.0–6.3), underweight body-mass index (OR:4.8, CI:3.6–6.5), female gender (OR:3.1, CI:2.8–3.6), and tuberculosis (OR:1.6, CI:1.4–1.8) were significantly associated with anemia. In this setting, management of anemia should focus on antiretroviral therapy, nutritional supplementation, and tuberculosis control. The high anemia prevalence among patients meeting criteria for antiretroviral therapy highlights the need for increased access to non-AZT nucleoside reverse transcriptase inhibitors in developing countries.
anemia; HIV; tuberculosis; India; malnutrition; resource-limited settings
To examine the HIV/sexually transmitted infection (STI)-related risk behaviours among community-based female sex workers (FSWs) and their clients in Yunnan Province, China, we performed a cross-sectional study of 705 FSWs and 100 male clients. We found that HIV seroprevalence among FSWs was 13.0% and the most prevalent STI was herpes simplex virus type 2 (HSV-2) (71.1%), followed by Chlamydia trachomatis (18.1%) and syphilis (8.8%). The 20% of FSWs who reported injection drug use also reported needle-sharing behaviours in the last three months. Drug-using FSWs had substantially higher HIV and HSV-2 prevalence, serviced more clients and had a longer history of sex work than non-using FSWs. In total, 57.0% of male clients did not consistently use condoms with FSWs, 2.0% reported illicit drug use and 17.0% had STI symptoms in the last year. The dual risk behaviours of drug-using FSWs and clients place them at greater risk of HIV infection. Intervention programmes must adopt comprehensive methods.
HIV; STI; IDU; female sex workers; male clients; prevalence; drug use; China
To assess trends in hemoglobin recovery among HIV-infected patients initiated on zidovudine-based combined antiretroviral therapy (cART) stratified by baseline hemoglobin level.
Hemoglobin data from non-pregnant adult patients initiating cART in rural north-central Nigeria between June 2009 and May 2011 was analyzed using a linear mixed effects model to assess the interaction between time, zidovudine-containing regimen, and baseline hemoglobin level on the outcome of subsequent hemoglobin level. Best fit curves were created for baseline hemoglobin in the 10th, 25th, 75th and 90th percentiles.
We included 313 patients with 736 measures of hemoglobin in the analysis (239 on zidovudine and 74 on non-zidovudine-containing regimens). Median hemoglobin increased over time in both groups, with differences in hemoglobin response over time related to baseline hemoglobin levels and zidovudine use (p = 0.003). The groups of patients on zidovudine at the 10th and 90th percentiles had downward sloping curves while all other groups had upward trending hemoglobin levels.
Though hemoglobin levels increased overall for patients on zidovudine-containing regimens, for those in the 10th and 90th percentiles hemoglobin levels trended downward over time. These results have implications for decisions regarding when to initiate, switch from or avoid the use of zidovudine.
zidovudine; AZT; anemia; hemoglobin; antiretroviral therapy
Individual and sexual partner characteristics may increase risk of abnormal cervical cytology among women in HIV-discordant relationships. Papanicolaou smears were obtained in a prospective cohort of Kenyan HIV-discordant couples. Of 441 women, 283 (64%) were HIV-infected and 158 (36%) were HIV-uninfected with HIV-infected partners. Overall, 79 (18%) had low-grade and 25 (6%) high-grade cervical abnormalities. Lack of male circumcision, male HSV-2 seropositivity and lower couple socioeconomic status were associated with cervical abnormalities (p<0.05). HIV-uninfected women with HIV-infected male sex partners (CD4>350 cells/µL) had the lowest prevalence of high-grade cervical lesions. HIV-infected women (CD4>350 cells/µL) and HIV-uninfected women with HIV-infected partners (CD4≤350 cells/µL) were at similar intermediate risk (P>0.05), and HIV-infected women (CD4≤350 cells/µL) had significantly higher risk of high-grade cervical abnormalities (p=0.05). Women in HIV-discordant relationships have high rates of cervical lesions and this may be influenced by couple-level factors, including HIV status and CD4 count of the infected partner.
Cancer; cervical; cytology; discordant couples; HIV
Given dramatic racial disparities in rates of HIV/STDs among African Americans, understanding broader structural factors that increase the risk for HIV/STDs is crucial. This study investigated incarceration history and unstable housing as two structural predictors of HIV risk behavior among 293 African Americans (159 men/134 women, Mage=27). Participants were recruited from an urban STD clinic in the southeastern U.S. Approximately half the sample had been incarcerated in their lifetime (54%), and 43% had been unstably housed in the past 6 months. Incarceration was independently associated with number of sex partners and the frequency of unprotected sex. Unstable housing was independently associated with the frequency of unprotected sex. However, these main effects were qualified by significant interactions: individuals with a history of incarceration and more unstable housing had more sex partners and more unprotected sex in the past three months than individuals without these structural barriers. Implications for structural-level interventions are discussed.
HIV/AIDS; sexual risk behavior; structural factors; housing; incarceration; racial disparities
Local genital tract inflammation stimulates Leukocyte activity and causes HIV shedding, potentially increasing HIV sexual infectiousness. Although there are available clinical markers for genital tract inflammation, such as urinary Leukocyte esterase, none have yet been examined in relation to HIV sexual risk behaviors.
To examine the association between urinary Leukocyte esterase and sexual practices.
Sexually active men living with HIV and receiving antiretroviral therapy (ART, N = 290) provided urine specimens and completed behavioral health assessments. HIV RNA tests and CD4 cell counts were abstracted from medical records. Urine specimens were analyzed for Leukocyte esterase using a standard point of care dipstick test.
Thirty-one (10.6%) participants tested positive for Leukocyte esterase. Logistic regression models did not indicate differences between men with elevated and un-elevated Leukocyte activity on demographic, health, recent STI symptoms and diagnoses, or substance use. However, men with elevated Leukocyte activity indicated significantly greater sexual behavior in the previous 3-months, including more recent unprotected sexual intercourse.
A simple over-the-counter urine test may serve as an indicator of sexual HIV infectiousness to inform further evaluation and treatment of genital tract inflammation, as well as condom use decisions during times of increased genital tract inflammation.
Genital tract inflammation; HIV transmission risks; Treatment as prevention
We describe an HIV-infected South African male who experienced two distinct episodes of disseminated giant molluscum contagiosum (MC) immune reconstitution inflammatory syndrome (IRIS) over a 6-year period. The first episode of MC-IRIS occurred with rapid virologic suppression following antiretroviral therapy (ART) initiation. The second episode occurred during a rapid increase in CD4 cells following stable viral suppression with second-line ART. His MC lesions then completely resolved during a reduction in CD4 count, despite maintaining virologic suppression. Nearly one year after the resolution of his giant MC-IRIS lesions, he maintains an undetectable viral load, but his level of immune deficiency has not improved. In the absence of well-controlled therapeutic trials, MC-IRIS presents important management challenges.
Molluscum contagiosum; HIV/AIDS, Immune reconstitution inflammatory syndrome (IRIS); antiretroviral therapy (ART); South Africa
HIV-syphilis co-infection is often cited as a major reason behind recent resurgence in syphilis prevalence among men who have sex with men (MSM) in China. Most published literatures explore factors associated with either HIV or syphilis, but not their co-infection. We analyzed data from a cross-sectional survey on MSM in seven Chinese cities. Snowball sampling was used to recruit participants for the survey. Socio-demographic and behavioral predictors for HIV-syphilis mono/co-infection were examined using ordinal logistic regression. Factor scores were used to summarize; 1) HIV related knowledge, and 2) access to HIV preventive services. Prevalence of HIV, syphilis, and their co-infection, among 2936 self-identified MSM, were 7.7%, 14.3%, and 2.6%, respectively. In the adjusted analysis, the significant positive correlates of poorer diagnoses (co-infection vs mono- & no infection or co- & mono-infection vs no infection) were −30 to 39 years and ≥40 years age, education up to senior high school, unprotected anal intercourse (UAI), recent STD symptoms, incorrect knowledge about routes of transmission, and access to preventive or counselling/testing services for HIV. For effective control of this dual epidemic, integrated HIV and syphilis surveillance and targeted intervention strategies for Chinese MSM are need of the hour.
HIV; syphilis; coinfection; homosexual; epidemiology
Despite advancements in the public’s understanding of HIV infection, stigma towards individuals living with HIV persists. Stigma has been associated with adverse health outcomes, including diminished engagement in care, poor medication adherence, and increased participation in HIV transmission risk behaviors. We evaluated the level of perceived stigma and its relationship to other psychosocial and medical factors among a sample of 201 individuals with HIV engaged in care. The Reece Stigma Scale was utilized to determine the level of felt stigma experienced by participants, with stigma scores ranging from 0 (no perceived stigma) to 45 (high perceived stigma). The overall mean stigma score was 21.7 (SD 8.7, range 9–45). In univariate analysis, stigma scores were higher among women, African Americans, younger participants, and individuals with less education. Higher stigma scores were also found among individuals who reported having fair to poor overall health, moderate to severe symptoms of depression and anxiety, and those with a current diagnosis of alcohol dependence, GAD, agoraphobia, pain disorder, and current smokers (p < 0.05 for all). After controlling for significant factors in univariate analyses, higher stigma scores were independently associated with individuals with anxiety symptoms (p< 0.001) and heterosexual individuals (p < 0.05). These analyses highlight that stigma persists among individuals with HIV and may play an important role in HIV care. The relationship between psychiatric disorders and psychosocial factors highlights an opportunity to develop interventions that will reduce both stigma and these common comorbidities.
stigma; HIV/AIDS; psychiatric disorders; psychological distress; mental illness
Little is known about the incidence of bacterial sexually transmitted infections (STIs) among HIV-infected vs. HIV-uninfected adolescents. This secondary analysis of a national, multisite study included adolescents aged 12–18 years who were behaviorally HIV-infected (n=346) or HIV-uninfected but at-risk (n=182). Incidence rates of bacterial STIs (gonorrhea, chlamydia [CT], and trichomonas [TV; females]) were calculated using Poisson modeling. Factors associated with incident STIs were explored using Cox proportional hazards modeling. HIV-infected vs. HIV-uninfected women had higher TV incidence (1.3 vs. 0.6/100 person-months; p=0.002). HIV-uninfected vs. HIV-infected women had higher CT incidence (1.6 vs. 1.1/100 person-months; p=0.04). Among women, demographic, behavioral, and HIV-related factors were associated with incident STIs. Among men, there were no differences in incident STIs. In this first analysis comparing STI incidence between HIV-infected and HIV-uninfected adolescents, bacterial STI incidence among women significantly differed by HIV status, and factors associated with incident STIs varied by STI and HIV status.
Adolescent; HIV; STI; Incidence
Herpes simplex virus type 2 (HSV-2) HIV co-infection is common and associated with increased risk of HIV transmission. HSV-2 seroprevalence was assessed on stored samples from baseline and one year follow-up from 81 patients identified with acute HIV infection and 81 age-matched chronically infected men. HSV-2 seroprevalence at baseline was lower for those with acute rather than chronic HIV-infection, 51.9 versus 71.6% (P = 0.01); relative risk 0.72 (95% confidence interval [CI] 0.57–0.92). Since HSV-2 seroprevalence is lower in those newly HIV-infected, the diagnosis of early HIV infection may allow for counselling to reduce subsequent HSV-2 acquisition.
herpes simplex virus type 2; HSV-2; seroprevalence; acute HIV infection; chronic HIV infection
HIV transmission risk is increased during ART use if individuals are not virologically suppressed and engage in high risk transmission behavior. Baseline data of HIV-infected MSM with recent history of risky behavior on ART for ≥3 months (n=139) was evaluated to assess predictors of detectable viremia and HIV transmission risk taking behavior. 24 subjects had VL>75 c/mL and 12 had VL>1000 c/mL. In multivariable regression analyses, subjects with VL>75 c/mL were more likely to be Black (OR 4.48, p=0.007), have lower CD4 cells (OR 0.727, p=0.005) and have used methamphetamines in the last month (OR 6.64, p=0.019). Subjects with VL>1000 c/mL were more likely to have lower CD4 cells (OR 0.494, p=0.004), report <90% adherence (OR 7.94; p=0.046) and have used methamphetamines in the last month (OR 10.01, p=0.034). Subjects with VL>75c/mL with the greatest transmission risk behavior (n=14) were more likely to be Black (OR 8.00, p=0.006), have lower CD4 cells (OR 0.657, p=0.009) and have used methamphetamines in the last month (OR 5.20, p=0.042). High risk HIV transmission behavior with viremia occurred in 10% of the cohort. Future efforts to reduce HIV transmission among MSM on ART will require combined interventions that target risk-taking behaviors and substance use.
Research emphasises the role that social structures play in shaping national HIV prevalence. This study examined how social, economic, and political contexts that may represent the confluence of individual capabilities and environmental affordances or constraints are associated with national HIV prevalence. Based on social-ecological perspectives, we examined social-structural dimensions in relation to national HIV prevalence. The study identified six publicly available nation-level social, political, and economic indices and examined their associations with national 2009 HIV prevalence across 225 nations. National indices, (a) education expenditures, (b) unemployment rate, (c) homicide rate, (d) freedom of religion, and (e) women’s social rights, altogether explained 43% of the variability in national HIV prevalence. Education expenditures, homicide rate, and freedom of religion were significant predictors of national HIV prevalence in the multivariate analysis. The present study identified nation-level factors that capture social, economic, and political contexts to explain between-nation differences in HIV prevalence. Findings extend current literature on the social-structural foundation of HIV-risk and the relationship between human rights and health. National safeguards that afford individuals the power to promote general quality of life and protection from structural violence may be most important to lowering overall rates of HIV transmission.
National HIV prevalence; national indices; social and structural factors; power; human rights
This study explores the feasibility of recruiting minority men who have sex with men (MSM) Facebook users for HIV prevention studies, and notes demographic and sexual risk behaviors. Facebook-registered MSM (N=118) were recruited using online and offline methods. Participants validated Facebook-user status through using a Facebook Connect (computer science) application. Participants were primarily Latino (60.2%) and African-American (28.0%), with 33.1% using social media to find sex partners. Black MSM social networking users reported engaging in a lower frequency (Coeff = −.48, p < .05) of unprotected receptive anal intercourse (URAI) compared to Latino MSM. Results suggest that minority social media-users can be recruited for HIV studies and that sexual risk behavioral differences exist among minority social networking users. Findings highlight the importance of incorporating technologies into population-focused HIV interventions.
HIV prevention; social networking; at-risk populations; MSM
There is currently no ‘gold standard’ for diagnosis of latent tuberculosis infection
(LTBI), and both the tuberculin skin test and interferon-gamma release assays (IGRAs) are
used for diagnosis; the latter have a higher sensitivity than tuberculin skin tests for
diagnosis of LTBI in HIV-infected individuals with lower CD4 counts. No evidence base
exists for selection of IGRA methodology to identify LTBI among human immunodeficiency
virus-infected patients in the UK. We prospectively evaluated two commercially available
IGRA methods (QuantiFERON-TB Gold In Tube [QFG] and T-SPOT.TB) for testing LTBI among
HIV-infected patients potentially nosocomially exposed to an HIV-infected patient with
‘smear-positive’ pulmonary tuberculosis. Among the exposed patients median CD4 count was
550 cells/µL; 105 (90%) of 117 were receiving antiretroviral therapy, of who 104 (99%) had
an undetectable plasma HIV load. IGRAs were positive in 12 patients (10.3%); QFG positive
in 11 (9.4%) and T-SPOT.TB positive in six (5.1%); both IGRAs were positive in five
patients (4.3%). There was one indeterminate QFG and one borderline T-SPOT.TB result.
Concordance between the two IGRAs was moderate (κ = 0.56, 95% confidence
interval = 0.27–0.85). IGRAs were positive in only 4 (29%) of 14 patients with previous
culture-proven tuberculosis. No patient developed tuberculosis during 20 months of
Interferon-gamma release assays; latent tuberculosis infection; HIV; screening; tuberculin skin test; AIDS; IGRA; Mycobacterium tuberculosis
Human immunodeficiency (HIV)-infected patients and men who have sex with men (MSM) have a higher rate of high-grade anal intraepithelial neoplasia (HGAIN), a likely precursor to anal cancer. This retrospective study describes the outcome of treating MSM with incident biopsy-proven HGAIN in an urban community health setting with access to outpatient ablation or operative treatment. The main outcome was freedom from HGAIN at follow-up. 153 met inclusion criteria; 86 (56%) were HIV-infected. Eighty (52%) received outpatient ablation, 49(61%) had a follow-up within 9 months. Among those, 26 (53%) were free of high-grade disease, 19 (39%) had high-grade disease; and 4 (8%) had unknown grading. In a logistic regression model, a lower extent of anal disease (1 quadrant vs. 2,3, or 4 quadrants) was significantly associated with a lower probability of high-grade disease (p-value 0.04.) HGAIN could be managed in a community health setting; however, systems are needed to ensure follow-up care.
HIV/AIDS; HPV; Treatment; Homosexual