Risk assessment of human monkeypox infections: A systematic review and meta-analysis.

Patients with human immunodeficiency virus (HIV) infection have sustained alterations in metabolism (lipids and insulin/glucose homeostasis) and body composition (fat distribution) that are proatherogenic (the Figure). HIV infection itself and/or its therapies may contribute to these alterations (the Table); although most effects are reversible, there are some possibly irreversible consequences of treatment. With the relative restoration to health seen in the era of highly active antiretroviral therapy (HAART), many traditional risk factors and promoters of dyslipidemia and diabetes also are present; they interact with HIV-specific inducers to worsen dyslipidemia and to increase the prevalence of insulin resistance and diabetes. Figure. Overview of the effects of HIV and its therapies on CVD risk. The contribution of traditional risk factors must be kept in mind, and they may occur with increased prevalence in people with HIV infection (eg, smoking). HIV, likely through the inflammatory response, and antiretroviral therapies independently affect many of the mediators of CVD risk. The effects on lipids are a prominent but complex example; HIV infection lowers LDL levels, but antiretroviral therapy raises LDL back up to normal levels. The bidirectional arrows indicate associations, but there is not yet adequate proof of causality. The dotted arrow between body composition and CVD indicates that body fat is known to affect the mediators such as dyslipidemia and insulin resistance but may also have a direct effect. FFA indicates free fatty acids; ARV, antiretroviral. View this table: Table. Effects of HIV Treatment These disturbances in lipid and glucose metabolism and renal disease may contribute, at least in part, to the excess cardiovascular disease (CVD) morbidity and mortality observed in HIV-infected individuals (the Figure). However, the relative contribution to excess CVD risk of traditional CVD risk factors, especially smoking, compared with these infection- and treatment-specific complications requires clarification. More prospective data with multivariable modeling are needed. …

With the development of effective therapies against human immunodeficiency virus (HIV), hepatitis C virus (HCV) infection has become a major cause of morbidity and mortality among patients with both infections (coinfection). In addition to the high prevalence of chronic HCV, particularly among HIV-infected injection drug users, the rate of incident HIV infections is increasing among HIV-infected men who have sex with men, leading to recommendations for education and screening for HCV in this population. Liver disease is the second leading and, in some cases, a preventable cause of death among coinfected patients. Those at risk for liver disease progression are usually treated with a combination of interferon (IFN) and ribavirin (RBV), which is not highly effective; it has low rates of sustained virologic response (SVR), especially for coinfected patients with HCV genotype 1 and those of African descent. Direct-acting antivirals might overcome factors such as immunodeficiency that can reduce the efficacy of IFN. However, for now it remains challenging to treat coinfected patients due to interactions among drugs, additive drug toxicities, and the continued need for combination therapies that include pegylated IFN. Recently developed HCV protease inhibitors such as telaprevir and boceprevir, given in combination with pegylated IFN and RBV, could increase the rate of SVR with manageable toxicity and drug interactions. We review the latest developments and obstacles to treating coinfected patients.

HIV disease: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

The Authors reply

The Uncertain Significance of Anti–Glomerular Basement Membrane Antibody Among HIV-Infected Persons With Kidney Disease

There is limited evidence from randomised controlled trials for STI control as an effective HIV prevention strategy. Improved STI treatment services have been shown to reduce HIV incidence in an environment characterised by an emerging HIV epidemic (low and slowly rising prevalence), where STI treatment services are poor and where STIs are highly prevalent. There is no evidence for substantial benefit from treatment of all community members. The addition of the Kamali trial to the existing evidence supports the data from the Rakai trial of no effect. There are, however, other compelling reasons why STI treatment services should be strengthened, and the available evidence suggests that when an intervention is accepted it can substantially improve quality of services provided. The Kamali trial shows an increase in the use of condoms, a marker for improved risk behaviors. Further community-based randomised controlled trials that test a range of alternative STI control strategies are needed in a variety of different settings. Such trials should aim to measure a range of factors that include health seeking behaviour and quality of treatment, as well as HIV, STI and other biological endpoints.

Self-treatment for sexually transmitted diseases (STD) is common, but little studied, in Thailand, and its influence on human immunodeficiency virus (HIV) infection is unknown. To assess STD self-treatment and self-prophylaxis behaviors as well as HIV risks and serostatus among northern Thai men. Cross-sectional report from a cohort of military conscripts (N = 869). HIV and STD seroprevalence and reported risk behaviors, including STD history and antibiotic self-treatment, were obtained. Associations between STDs and self-treatment or prophylaxis and HIV infection were analyzed using t-tests, odds ratios, and logistic regression. The prevalence rate for HIV was 12.3%, and for syphilis it was 2.2%. Men who were seropositive for HIV were more likely to report having sex with commercial sex workers (OR 9.1), to have had an STD (OR 5.96) and to report inconsistent condom use with commercial sex workers (OR 3.13). Of 282 men reporting any STD, 65.2% treated themselves with antibiotics, and 8.5% used them before commercial sex. Among those who frequented commercial sex workers, 98.7% took preventive steps after sex by increasing urine output (69.2%), washing the genital area (28.9%), and using antibiotics (0.9%). Men reporting STD self-treatment were less likely to be HIV infected (OR 0.53; 95% CI 0.31, 0.93). These men are attempting to prevent HIV and STDs. Self-treatment with antibiotics may lower HIV risks associated with bacterial STD in a high-prevalence population.

There is limited evidence from randomised controlled trials for STI control as an effective HIV prevention strategy. Improved STI treatment services have been shown to reduce HIV incidence in an environment characterised by an emerging HIV epidemic (low and slowly rising prevalence), where STI treatment services are poor and where STIs are highly prevalent. There is no evidence for substantial benefit from treatment of all community members. There are however other compelling reasons why STI treatment services should be strengthened and the available evidence suggests that when an intervention is accepted it can substantially improve quality of services provided. Further community based randomised controlled trials that test a range of alternative STI control strategies are needed in a variety of different settings. Such trials should aim to measure a range of factors that include health seeking behaviour and quality of treatment as well as HIV, STI and other biological endpoints.

Objective To understand the human immunodeficiency virus(HIV) infection status and features of sexual behavior among men who have sex with men (MSM) and receive voluntary counseling and serological testing appointed through a web-based registering system to analyze the related factors. Methods The MSM who have homosexual behavior in nearly a year were recruited for HIV, syphilis and hepatitis C virus (HCV) antibody assay in peripheral blood and a face-to-face questionnaire survey was conduct among them to obtain the information about their demographic characteristics and sexual behavior.Binary logistic regression model was used to identify the risk factors associated with HIV infection. Results A total of 400 MSM were enrolled in our study, the median age is 27 years old, the unmarried MSM accounted for 65.25%, 56.00% of them had high education level and the awareness rate of knowledge regarding HIV was 92.75%. The percentages of using condom at latest homosexual or heterosexual behavior were 78.96% and 79.82%. The HIV incidence was 7.25% (29/400). Age, condom use at each homosexual or heterosexual behavior, the awareness rate of knowledge regarding HIV, sexually transmitted disease (STD) infection, Treponema pallidum infection were associated with HIV infection. Conclusions MSM receiving web appointed HIV counseling and testing had high prevalence of risk behaviors and high HIV infection rate, but the rate of condom use was relatively low. It is necessary to strengthen the promotion of HIV test through web based appointment. The integrated mechanism for the prevention and control of STD and AIDS should be improved and effective target behavior intervention in MSM should be strengthened in our intervention programs. Key words: MSM; HIV; Virus

S tudies published over the past 3 years have tracked the incidence and course of human immunodeficiency virus (HIV) infection in relation to cardiac illness in both children and adults. 1 These studies show that subclinical echocardiographic abnormalities independently predict adverse outcomes and identify high-risk groups to target for early intervention and therapy.The Joint United Nations Program on HIV/AIDS estimates that 36.1 million people were living with HIV infection at the end of the year 2000. 2 If 8% to 10% of patients develop symptomatic heart failure over a 2-to 5-year period, 3 then 3 million cases of HIV-related heart failure will present during that period. 1 Cardiovascular manifestations of HIV have been altered by the introduction of highly active antiretroviral therapy (HAART) regimens.On one hand, HAART has significantly modified the course of HIV disease, lengthened survival, and improved the quality of life of HIV-infected patients.On the other hand, the early data have raised concerns that HAART is associated with an increase in both peripheral and coronary arterial diseases. 1The HAART-associated changes are relevant only to the minority of HIV-infected individuals worldwide who have access to HAART.Thus, studies conducted before HAART became available remain globally applicable.In this review article, the principal HIV-associated cardiovascular manifestations will be discussed, with an emphasis on new knowledge about prevalence, pathogenesis, and treatment.

Human Immunodeficiency Virus Pre-Exposure Prophylaxis: Is it the Answer?

Neisseria gonorrhoeae and Chlamydia trachomatis among human immunodeficiency virus-infected women.

Most previous studies of clinical presentation and risk factors in early human immunodeficiency virus (HIV) infection have relied on retrospective analyses and referred seroconverters, and thus were subject to possible bias. To apply a method based on measurement of prevalent HIV-1 p24 antigenemia for identification of risk factors for newly acquired HIV infection and to describe the signs and symptoms of acute HIV infection. Nested case-control study in Pune, India. HIV antibody-negative persons attending 2 sexually transmitted disease (STD) clinics between May 1993 and June 1996. Prevalent p24 antigenemia, risk factors for HIV infection, and clinical symptoms of acute primary HIV infection. Of 3874 HIV antibody-negative persons tested, 58 (1.5%) were p24 antigen positive at initial presentation to the clinics. Unprotected sexual contact with a commercial sex worker (CSW) was reported by 39 (77%) of the 51 p24 antigenemic men, compared with 131 (51 %) of 255 control men (adjusted odds ratio [AOR], 3.4; 95% confidence interval [CI], 1.2-9.6; P=.02). The presence of an active genital ulcer at the time of screening was found in 46 (79%) of the 58 p24 antigenemic men and women, compared with 137 (47%) of the 290 control subjects (AOR, 4.2; 95% CI, 2.0-9.0; P<.001). Signs and symptoms independently associated with p24 antigenemia in HIV antibody-seronegative persons included fever, which was reported by 28 (48%) of the 58 p24 antigenemic subjects, but only 52 (18%) of the 290 control subjects (AOR, 4.7; 95% CI, 2.4-9.0; P<.001). Joint pain was reported by 10% of subjects recently HIV infected, compared with 2% of the control subjects (AOR, 6.5; 95% CI, 1.7-24.8; P=.006). Night sweats were reported by 9% of the p24 antigenemic, but only 1% of the control subjects (AOR, 9.1; 95% CI, 1.7-47.6; P=.009). Overall, fever, joint pain, and/or night sweats were reported in 27 (47%) of the 58 subjects with recent HIV infection. This systematic case-control study of p24 antigen screening in HIV-seronegative patients attending STD clinics in India identified unprotected sex with a CSW and a genital ulcer as independent risk factors associated with newly acquired HIV infection. In addition, p24 antigen positivity identified recent fever, night sweats, and arthralgias as symptoms that may be predictive of recent HIV infection. In a study of patients attending STD clinics in India, screening for p24 antigen in HIV antibody-negative persons was found to be a reliable and effective research method for determining recent risk behavior and identifying clinical signs of acute primary HIV infection.

Understanding the current epidemiology of human immunodeficiency virus (HIV) infection in Thailand will facilitate more effective national HIV prevention programs. This study aimed to determine the prevalence and risk factors for HIV infection among young Thai men. A total survey was conducted of Royal Thai Army new conscripts, participating in the national HIV surveillance in November 2010 and May 2011. Behavioral risk factors for HIV infection were determined using a standardized survey questionnaire in the total study population and men who have sex with men (MSM) subgroup. A total of 301 (0.5%) HIV infected young Thai men were identified from the total study population (63,667). Independent risk factors associated with HIV infection among the total study population included being single (adjusted Odds Ratio [AOR] 1.6, 95% Confidence Interval [CI] 1.1-2.2), having no formal education (AOR 6.5, 95% CI 2.3-18.4) or a bachelor's degree (AOR 1. 8, 95% CI 1.0-3.0), engaging in bisexual (AOR 3.7, 95% CI 2.4-5. 6) or exclusively homosexual activity (AOR 14.4, 95% CI 10.4-19.8), having a history of Sexually Transmitted Infection (STI) (AOR 2.3, 95% CI 1.6-3.3) and having sex in exchange for gifts/money (AOR 2.0, 95% CI 1. 5-2.8). A total of 4,594 (7.9%) MSM were identified, of which 121 (2.6%) were HIV infected. The prevalence of HIV infection among MSM in urban (2.8%) and rural (2.4%) areas were relatively comparable (p-value = 0.44). Of the identified MSM, 82.5% reported having sexual desire with females only. Risk factors associated with HIV infection in the MSM subgroup included living in the western region (AOR 3.5, 95% CI 1.2-10.4), having a bachelor's degree (AOR 2.7, 95% CI 1.2-5.7), having a history of exclusive receptive (AOR 3.6, 95% CI 1.6-7.7) or versatile anal sex (AOR 4.7, 95% CI 3.0-7.5) and history of having sex in exchange for gifts/money (AOR 2.3, 95% CI 1.5-3.5). The prevalence of HIV infection among young Thai men has continued to be below 0.5% in 2010 and 2011. High risk sexual activity, including MSM, played a major role in the HIV epidemic among this population. Effective HIV prevention programs should cover MSM who have heterosexual desire as well as having sex in exchange for gifts/money and be implemented in both urban and rural areas.

IntroductionUnderstanding the current epidemiology of human immunodeficiency virus (HIV) infection in Thailand will facilitate more effective national HIV prevention programs. This study aimed to determine the prevalence and risk factors for HIV infection among young Thai men.MethodsA total survey was conducted of Royal Thai Army new conscripts, participating in the national HIV surveillance in November 2010 and May 2011. Behavioral risk factors for HIV infection were determined using a standardized survey questionnaire in the total study population and men who have sex with men (MSM) subgroup.ResultsA total of 301 (0.5%) HIV infected young Thai men were identified from the total study population (63,667). Independent risk factors associated with HIV infection among the total study population included being single (adjusted Odds Ratio [AOR] 1.6, 95% Confidence Interval [CI] 1.1–2.2), having no formal education (AOR 6.5, 95% CI 2.3–18.4) or a bachelor’s degree (AOR 1. 8, 95% CI 1.0–3.0), engaging in bisexual (AOR 3.7, 95% CI 2.4–5. 6) or exclusively homosexual activity (AOR 14.4, 95% CI 10.4–19.8), having a history of Sexually Transmitted Infection (STI) (AOR 2.3, 95% CI 1.6–3.3) and having sex in exchange for gifts/money (AOR 2.0, 95% CI 1. 5–2.8). A total of 4,594 (7.9%) MSM were identified, of which 121 (2.6%) were HIV infected. The prevalence of HIV infection among MSM in urban (2.8%) and rural (2.4%) areas were relatively comparable (p-value = 0.44). Of the identified MSM, 82.5% reported having sexual desire with females only. Risk factors associated with HIV infection in the MSM subgroup included living in the western region (AOR 3.5, 95% CI 1.2–10.4), having a bachelor’s degree (AOR 2.7, 95% CI 1.2–5.7), having a history of exclusive receptive (AOR 3.6, 95% CI 1.6–7.7) or versatile anal sex (AOR 4.7, 95% CI 3.0–7.5) and history of having sex in exchange for gifts/money (AOR 2.3, 95% CI 1.5–3.5).ConclusionThe prevalence of HIV infection among young Thai men has continued to be below 0.5% in 2010 and 2011. High risk sexual activity, including MSM, played a major role in the HIV epidemic among this population. Effective HIV prevention programs should cover MSM who have heterosexual desire as well as having sex in exchange for gifts/money and be implemented in both urban and rural areas.