Acquired Human Immunodeficiency Virus Infection Research Articles

Severe airflow obstruction in vertically acquired HIV infection.

It is becoming increasingly clear that human immunodeficiency virus (HIV) infection, either independently or in concert with opportunistic infections like pulmonary tuberculosis, is a risk factor for the development of chronic airflow limitation. In the majority of patients the etiology of this obstructive ventilatory defect is multifactorial. Post-infectious obliterative bronchiolitis, post-tuberculous lung damage (including bronchiectasis), immune reconstitution and the direct effects of HIV viral infection may all play a role. With increases in life expectancy and decreases in infectious complications in patients taking antiretroviral medications, the importance of HIV-associated chronic lung disease as a cause of pulmonary disability is likely to increase. This is particularly relevant in regions like sub-Saharan Africa, where both HIV infection and tuberculosis are highly prevalent. Here, to illustrate the complexity of this interaction, we present the case of a 15-year-old girl with vertically acquired HIV infection, multiple episodes of pulmonary infection, and severe airflow obstruction.

Preventing and managing HIV infection in infants, children, and adolescents in the United States.

1. George K. Siberry, MD, MPH* 1. *Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD * Abbreviations: ART: : antiretroviral therapy ARV: : antiretroviral cART: : combination antiretroviral therapy CDC: : Centers for Disease Control and Prevention EIA: : enzyme-linked immunoassay HIV: : human immunodeficiency virus MAC: : Mycobacterium avium complex MMR: : measles-mumps-rubella MSM: : men who have sex with men MTCT: : maternal-to-child transmission OI: : opportunistic infection PCP: : Pneumocystis pneumonia PCR: : polymerase chain reaction STI: : sexually transmitted infection Effective prevention strategies have reduced the risk of perinatal transmission of human immunodeficiency virus (HIV) infection to less than 1% to 2% in the United States, but failures to fully implement these strategies result in continued preventable infant HIV infections. In addition, the increasing number of sexually acquired HIV infections in adolescents underscores the important role of the pediatrician in preventing and diagnosing HIV infection in youth. After completing this article, readers should be able to: 1. Recognize the important role that the pediatrician plays in the prevention, detection, and care of patients infected with and affected by human immunodeficiency virus (HIV). 2. Understand the epidemiology of HIV infection in infants, children, and adolescents. 3. Select the proper HIV diagnostic testing plan for infants, children, and adolescents. 4. Plan the comprehensive management of HIV-exposed infants. 5. Recognize the clinical conditions suggestive of HIV infection, including the major opportunistic infections seen in patients with HIV/AIDS. 6. Understand the principles, monitoring, and complications of HIV treatment in infants, children, and adolescents. Since the first description of infants with human immunodeficiency virus (HIV) infection in the early 1980s, (1)(2) tremendous advances have been made in the understanding, prevention, and treatment of HIV infection. Effective prevention strategies have reduced the risk of perinatal transmission, or maternal-to-child transmission (MTCT), of HIV infection to less than 1% to 2% in the United States, and the World Health Organization has made global elimination of new infant HIV infections a realistic target by 2015. (3) For those children who have HIV infection, the development of potent antiretroviral (ARV) drugs has transformed a once progressive and often fatal infection for children into a chronic condition …

Mother-to-child transmission of human immunodeficiency virus (HIV) – experience of two AIDS centers from Romania

Mother-to-child transmission of human immunodeficiency virus (HIV) infection decreased in the last years due to the implementation of: HIV testing, antiretroviral (ARV) medications, delivery by cesarean section and discouraging breastfeeding. In Romania, pregnant women could acquire HIV infection as adults or could have a long history of disease and ARV treatment (ART), belonging at the Romanian cohort. Aim: to evaluate the risk factors for HIV transmission from mother-to-child during pregnancy and delivery. Retrospective study based on patients’ electronic medical records files and AIDS database (Cluj and Mures AIDS Center) of all children born by HIV infected women during Jan 2008 to Dec 2013 for risk factors of HIV transmission. We evaluated women for related risk factors: age, AIDS stage, Romanian cohort membership, plasma viral load during pregnancy, HAART treatment during pregnancy, mode of delivery, infant ART prophylaxis. Statistical analysis was performed with chi square test and multiple regression. 54 newborns were born by 45 HIV infected women during the study period, 8 (14.81%) of them being diagnosed with HIV infection. The women’s average age was 23.82 (min 18, max 38), 29 women belonged to the Romanian cohort. The AIDS stage was: A for 12 patients, B for 19 patients and C for 23 patients. 6 out of 45 women (13.33%) didn’t receive ART during pregnancy, being diagnosed during labor. Plasma viral load during pregnancy was determined for 36 women: undetectable for 8 women, less than 400 copies/mL for 5 women and more than 400 copies/mL for 23 patients. Delivery was with elective caesarean section for 47 newborns (87.03%). Infant ART prophylaxis was administered in 48 newborns (88.88%). The risk of mother-to-child HIV transmission was significantly lower with: ART during pregnancy (p<0.001) not important of ARV association, cesarean section (p<0.001) and infants’ ART prophylaxis (p=0.03). The risk of mother-to child HIV infection is high in Romania; the percent of women not tested for HIV infection during pregnancy is low; the risk of HIV infection transmission was significantly lowered by ART during pregnancy and in infant, as prophylaxis, and by elective caesarean section.

ACOG Committee Opinion no 595: Committee on Gynecologic Practice: Preexposure prophylaxis for the prevention of human immunodeficiency virus.

Preexposure prophylaxis is defined as the administration of antiretroviral medications to individuals who are not infected with human immunodeficiency virus (HIV) and are at the highest risk of acquiring HIV infection. In combination with other proven HIV-prevention methods, preexposure prophylaxis may be a useful tool for women at the highest risk of HIV acquisition. Obstetrician-gynecologists involved in the care of women using preexposure prophylaxis must reinforce adherence to daily medication. The Centers for Disease Control and Prevention's guidance for preexposure prophylaxis is likely to evolve in the coming years, and obstetrician-gynecologists should remain aware of new developments in this area. Risk reduction for all women at risk of HIV infection should include counseling about testing, safe-sex practices (including condom use), and other behavioral interventions.

Antiretrovirals for HIV prevention: new hope and opportunity

One of the greatest challenges facing the world today is the control of the Human Immunodeficiency Virus (HIV) epidemic. At the end of 2012, an estimated 35.3 million people were living with HIV. While intravenous drug use is the major route of transmission in several countries, sexual transmission is the dominant mode of HIV spread globally, with a concomitant epidemic in infants born to HIV infected mothers. Although many regions and countries are showing signs of declining or stabilizing epidemics, some countries and populations continue to have unacceptably high HIV prevalence and incidence rates. Antiretroviral therapy (ART) has a dual role of both preventing morbidity and mortality associated with advancing HIV disease and preventing HIV transmission. Since 2005, significant advances in scaling-up ART have been achieved globally and approximately 9.7 million people in low and middle-income countries were already receiving ART by the end of 2012. Provision of ART to all those that require it is essential but will not be sustainable if equal effort is not invested in preventing new HIV infections. Significant advances in HIV prevention have been achieved in the last decade. The scale up of prevention for mother-to-child transmission for example has resulted in a drastic decline in new HIV infections among children; which have decreased by 52% between 2001 and 2012. Noteworthy achievements have also been realised in scaling-up the implementation of circumcisions for HIV prevention, with about 3.2 million adult African men having received services for voluntary medical male circumcision by the end of 2012. Important new developments in preventing HIV have emerged over the past 3 years that dramatically expand the available prevention strategies for reducing sexually acquired HIV infections, especially for high-risk populations. Specifically, the use of antiretroviral agents, as topical or oral prophylaxis, has been shown to successfully reduce the risk of sexually transmitted. Despite the numerous challenges in implementing these strategies, at high adherence, these new interventions have created a newfound optimism in HIV prevention. The challenge now is to mobilise the political will and resources to translate these biomedical HIV prevention technologies into public health impact to turn the tide of the epidemic and perhaps end it.

Women and Children First: The Impact of Sexually Transmitted Infections on Maternal and Child Health.

Women and Children First: The Impact of Sexually Transmitted Infections on Maternal and Child Health.

Higher rate of hepatitis events in patients with human immunodeficiency virus, hepatitis B, and hepatitis D genotype II infection: A cohort study in a medical center in southern Taiwan

The epidemiology and impact of hepatitis δ virus (HDV) on hepatic outcomes and virological and immunological responses to highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) patients coinfected with hepatitis B virus (HBV) in northern Taiwan have been reported. However, the epidemiology and impact of HDV infection in HIV-HBV coinfection patients in southern Taiwan remains uncertain. In this cohort study, a total of 64 HIV patients coinfected with HBV were identified between January 1, 2009 and May 30, 2012. The seroprevalence of anti-HDV antibodies, HDV genotyping, clinical manifestations and hepatic outcomes were compared between the patients with and without HDV coinfection, and laboratory examinations and hepatic outcomes were recorded. Among the 64 HIV patients coinfected with HBV, seven were seropositive for HDV (10.9%). There were no statistically significant differences in risk factors for acquiring HIV infection. During a median observation period of 27.8 months, the adjusted hazard ratio of HDV and HBV genotype (type B vs. non-type B) on hepatitis flare-ups were 62.132 (p = 0.04) and 0.028 (p = 0.01), respectively. All seven patients had genotype II and were HDV viremic. The phylogenetic tree analysis and clinical history evaluation did not identify any clusters of HDV infection. HDV infection resulted in higher rate of hepatitis flare-ups, but it did not have a statistical significance on HIV progression and immunological response to HAART. Whether higher rate of HDV viremia has worse impact on the hepatic outcomes requires further investigation.

Immunology of pediatric HIV infection

Most infants born to human immunodeficiency virus (HIV)-infected women escape HIV infection. Infants evade infection despite an immature immune system and, in the case of breastfeeding, prolonged repetitive exposure. If infants become infected, the course of their infection and response to treatment differs dramatically depending upon the timing (in utero, intrapartum, or during breastfeeding) and potentially the route of their infection. Perinatally acquired HIV infection occurs during a critical window of immune development. HIV's perturbation of this dynamic process may account for the striking age-dependent differences in HIV disease progression. HIV infection also profoundly disrupts the maternal immune system upon which infants rely for protection and immune instruction. Therefore, it is not surprising that infants who escape HIV infection still suffer adverse effects. In this review, we highlight the unique aspects of pediatric HIV transmission and pathogenesis with a focus on mechanisms by which HIV infection during immune ontogeny may allow discovery of key elements for protection and control from HIV.

Cholangiocarcinoma in a Young Woman With Perinatally Acquired HIV

Cholangiocarcinoma in a Young Woman With Perinatally Acquired HIV

Low perception of sexual behaviours at risk for human immunodeficiency virus infection among blood donors who call the AIDS/STI Help Line in Italy.

In Italy, the circulation of human immunodeficiency virus (HIV) has expanded to include population groups that do not perceive themselves to be "at risk" of HIV infection and who do not even consider undergoing HIV testing. The aim of this study was to describe the socio-demographic and behavioural characteristics, and perceived risk of HIV infection in a sample of blood donors who reported never having been tested for HIV. A questionnaire was administered to a sample of donors who called the Italian National AIDS/STI Help Line and reported never having been tested for HIV. The study sample consisted of 164 blood donors: 29.3% had given blood in the preceding 2 years. With regards to at-risk behaviours, 39.6% of the donors interviewed were heterosexuals who had sexual contacts with multiple partners, and 5.5% were men who had sex with multiple male partners. Sexual contacts with female sex workers were reported by 11.6% of first-time donors and 25.7% of repeat donors. Of the 164 donors interviewed, 125 (76.2%) said that the main reason that they had never been tested for HIV was that they did not consider themselves at risk. Among these, 56 (44.8%) reported that they would have sexual contacts with a sex worker, 52 (41.6%) reported that they would have sexual contacts with someone having more than one sexual partner, and 36 (28.8%) reported that they would have sexual contacts without using a condom. All the donors interviewed reported that they had never been tested for HIV despite the fact that they had been certainly been tested upon blood donation. These results show that some sexual behaviours may not be perceived as behaviours at risk for acquiring HIV infection. These findings suggest that not all blood donors are knowledgeable about HIV risk behaviours and that an explicit pre-donation questionnaire and effective counselling continue to be important for the selection of candidate donors.

Laboratory Diagnosis of HIV in Adults: A Review of Current Methods

Of the estimated 1.2 million people infected with human immunodeficiency virus (HIV) in the United States, 20% are unaware of their diagnosis. Improved methods of HIV testing could decrease this number, as well as identify those who have recently acquired HIV infection and are at the most critical stage of infectivity. People with acute HIV infection have demonstrated enhanced transmission of HIV in multiple epidemiologic and pathogenetic studies. More than 50 000 HIV infections occur annually in the United States, and 30%-50% have been attributed to persons with recent infection. The original HIV diagnostic testing algorithm was developed by the Centers for Disease Control and Prevention in 1989. Recently proposed alterations to the algorithm would incorporate advancements made in HIV diagnostic testing, thereby increasing sensitivity while reducing turnaround time and cost. Improved diagnosis of acute HIV, and HIV type 2 in particular, would be expected. Knowledge of the available laboratory methods for HIV diagnosis is essential in the fight against the spread of HIV.

The Role of Human Papillomavirus in Human Immunodeficiency Virus Acquisition in Men who Have Sex with Men: A Review of the Literature

Human Papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide. Incidence rates of HPV infection among human immunodeficiency virus (HIV)-infected individuals are well documented and are several-fold higher than among HIV-uninfected individuals. Few studies have demonstrated an increased risk for acquiring HIV infection in those with HPV infection, and this risk seems to be higher when HPV strains are of high-risk oncogenic potential. The estimated prevalence of high-risk oncogenic HPV infection is highest in men who have sex with men (MSM), a particularly vulnerable group with high prevalence rates of HIV infection and other STIs. In this paper, we provide a comprehensive review of the available literature on the role of HPV infection in HIV acquisition. Our review includes data from cross-sectional and longitudinal studies.

Fulminant Subacute Sclerosing Panencephalitis in an Individual With a Perinatally Acquired Human Immunodeficiency Virus Infection

BACKGROUND Case reports of subacute sclerosing panencephalitis (SSPE) in individuals with human immunodeficiency virus (HIV) infection are scarce, and the natural history is unclear. To our knowledge, a fulminant presentation has not yet been described. OBJECTIVE To describe a case of fulminant SSPE in an individual with a perinatally acquired HIV infection. DESIGN Case report and literature review. SETTING Christian Medical College Hospital, Vellore, India. PATIENT A 17-year-old boy with a perinatally acquired HIV infection. RESULTS The patient presented with subacute-onset cognitive decline and myoclonic jerks with rapid deterioration of health (the patient died within 12 weeks of onset). The findings from magnetic resonance imaging and electroencephalography and the cerebrospinal fluid and serum measles antibody titers were suggestive of SSPE. The fulminant presentation in this case needs to be noted. CONCLUSIONS Along with the better life expectancy of HIV-infected individuals, there may be an increase in the incidence of SSPE in this population. Fulminant SSPE may be added to the spectrum of measles-associated neurological disorders in HIV.

Different HCV Genotype Distributions of HIV-Infected Individuals in Henan and Guangxi, China

BackgroundDue to shared transmission routes, hepatitis C virus (HCV) infection is highly prevalent among people infected with human immunodeficiency virus (HIV). Highly active antiretroviral therapy (HAART) is associated with hepatotoxicity, leading to the negative effects on patients with HIV/HCV co-infection. In order to provide valuable information for HCV management in this particular population, we investigated the HCV genotypes in HIV-infected individuals from Henan and Guangxi, the two provinces with the most HIV-infected cases in China.MethodsIndividuals, who acquired HIV infection through various risk routes, were recruited from Henan and Guangxi. Test of antibodies against HCV (anti-HCV) was conducted, and detection of HCV RNA was performed by PCR amplification. HCV subtypes were determined by direct sequencing of amplicons, followed by phylogenetic analysis.ResultsWe recruited a total of 1,112 HIV-infected people in this present study. Anti-HCV was detected from 218 (50.1%) patients from Henan and 81 (12.0%) patients from Guangxi, respectively. The highest prevalence of HIV/HCV co-infection was observed from FBDs (former blood donors) (87.2%) in Henan and IDUs (intravenous drug users) (81.8%) in Guangxi, respectively. The seroprevalence rate of HCV among people with sexual contact was significantly higher in Henan than in Guangxi (18.7% vs. 3.5%, P<0.05). The positive rate of HCV RNA in Henan and Guangxi was 30.6% (133/435) and 11.2% (76/677), respectively. Moreover, we found that 20 anti-HCV negative samples were HCV positive by PCR amplification. HCV subtype 1b (52.7%) was predominant in Henan, followed by subtype 2a (41.9%). The most frequently detected subtypes in Guangxi were 6a (35.6%) and 3b (32.9%).ConclusionThe HCV genotype distributions were different in HIV-infected people from Henan and Guangxi. HIV/HCV co-infection was not only linked to the transmission routes, but also associated with the geographic position.

Cardiac disease in adolescents with delayed diagnosis of vertically acquired HIV infection.

At least one-third of human immunodeficiency virus (HIV)-infected infants survive to adolescence even without antiretroviral therapy (ART), but are at high risk of complications including cardiac disease. We investigated the characteristics of cardiac disease among adolescents with HIV infection diagnosed in late childhood who were receiving ambulatory HIV care in Harare, Zimbabwe. Consecutive adolescents with vertically acquired HIV attending 2 HIV outpatient treatment clinics were studied. Assessment included clinical history and examination, and 2-dimensional, M-mode, pulsed- and continuous-wave Doppler echocardiography. Of 110 participants (47% male; median age, 15 years; interquartile range, 12-17 years), 78 (71%) were taking ART. Exertional dyspnea, chest pain, palpitations, and ankle swelling were reported by 47 (43%), 43 (39%), 10 (9%), and 7 (6%), respectively. The New York Heart Association score was ≥ 2 in 41 participants (37%). Echocardiography showed that 74 participants (67%) had left ventricular (LV; septal and/or free wall) hypertrophy and 27 (24%) had evidence of impaired LV relaxation or restrictive LV physiology. The estimated pulmonary artery systolic pressure (ePASP) was >30 mm Hg in 4 participants (3.6%); of these 2 also had right ventricular (RV) dilatation. Another 32 participants (29%), without elevated ePASP, had isolated RV dilatation. A significant burden of cardiac disease was seen among adolescents with vertically acquired HIV infection. More than half were asymptomatic yet had significant echocardiographic abnormalities. These findings highlight the need to screen this population in order to better define the geography, natural history, etiopathogenic mechanisms, and management (including the timing and choice of optimal therapeutic ART and cardiac drug interventions) to prevent development and/or progression of HIV-associated cardiac disease.

British HIV Association guidelines for the management ofHIVinfection in pregnant women 2012

British HIV Association guidelines for the management of<scp>HIV</scp>infection in pregnant women 2012

Correlates of Mother-to-Child Transmission of Human Immunodeficiency Virus in the United States and Puerto Rico

The most common mode of human immunodeficiency virus (HIV) infection in children is mother-to-child transmission during pregnancy, labor, and delivery. The use of current guidelines can prevent a significant proportion of perinatally acquired HIV infections. Current recommendations for prevention include HIV testing early in pregnancy; combination antiretroviral prophylaxis during pregnancy; administration of zidovudine during labor and to the neonate, planned cesarean delivery before labor when indicated, and avoidance of breast-feeding. Implementation of these recommendations has resulted in a marked decline in the number of perinatally infected infants during the past decade. Failure to use any of these interventions is a missed opportunity for prevention of perinatal HIV transmission. This study explored the association between missed prevention opportunities and mother-to-child transmission in 15 US jurisdictions for birth years 2005 through 2008, while controlling for variables associated with transmission. Data regarding HIV-infected women who gave birth to live infants were obtained from the Enhanced Perinatal Surveillance system. Multivariable logistic regression analysis was used to control for demographic, behavioral, clinical, and missed opportunity variables associated with mother-to-child transmission. HIV infection was diagnosed in 179 infants (2.2%) among the 8054 births to HIV-infected women during the 4-year study period. There was at least one missed opportunity for prevention of mother-to-child transmission in 74.3% of infected infants and 52.1% of uninfected infants. A total of 7757 mother–infant pairs had sufficient data for analysis. The adjusted data showed that the odds of having an HIV-infected infant were higher for women who received late testing (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI], 1.5–4.0) or no prenatal antiretroviral medications (aOR, 3.5; 95% CI, 2.0–6.4). The odds of having a HIV-infected infant for women who breastfed were >4-fold higher than for those that did not (aOR, 4.6; 95% CI, 2.2–9.8). The odds were >2-fold higher among women with CD4 counts <200 cells per microliter compared with those with CD4 counts ≥500 cells per microliter (aOR, 2.4; 95% CI, 1.4–4.2). Similarly, the odds for women with substance abuse were twice those for women without this risk factor (aOR, 2.0; 95% CI, 1.4–2.9). These findings indicate that further decreasing, or ultimately eliminating, perinatal HIV infections in the United States will require increased attention to the following interventions: an increase in earlier HIV diagnosis, lowering CD4 counts through the use of prenatal antiretroviral medications, substance abuse treatment, and avoidance of breast-feeding. Failure to use any of these interventions represents a missed opportunity for prevention.

Chronic Lung Disease in Adolescents With Delayed Diagnosis of Vertically Acquired HIV Infection

Long-term survivors of vertically acquired human immunodeficiency virus (HIV) infection are reaching adolescence in large numbers in Africa and are at high risk of delayed diagnosis and chronic complications of untreated HIV infection. Chronic respiratory symptoms are more common than would be anticipated based on the HIV literature. Consecutive adolescents with presumed vertically acquired HIV attending 2 HIV care clinics in Harare, Zimbabwe, were recruited and assessed with clinical history and examination, CD4 count, pulmonary function tests, Doppler echocardiography, and chest radiography (CXR). Those with suspected nontuberculous chronic lung disease (CLD) were scanned using high-resolution computed tomography (HRCT). Of 116 participants (43% male; mean age, 14 ± 2.6 years, mean age at HIV diagnosis, 12 years), 69% were receiving antiretroviral therapy. Chronic cough and reduced exercise tolerance were reported by 66% and 21% of participants, respectively; 41% reported multiple respiratory tract infections in the previous year, and 10% were clubbed. More than 40% had hypoxemia at rest (13%) or on exercise (29%), with pulmonary hypertension (mean pulmonary artery pressure >25 mm Hg) in 7%. Forced expiratory volume in 1 second (FEV(1)) was <80% predicted in 45%, and 47% had subtle CXR abnormalities. The predominant HRCT pattern was decreased attenuation as part of a mosaic attenuation pattern (31 of 56 [55%]), consistent with small airway disease and associated with bronchiectasis (Spearman correlation coefficient (r(2) = 0.8) and reduced FEV(1) (r(2) = -0.26). Long-term survivors of vertically acquired HIV in Africa are at high risk of a previously undescribed small airway disease, with >40% of unselected adolescent clinic attendees meeting criteria for severe hypoxic CLD. This condition is not obvious at rest. Etiology, prognosis, and response to treatment are currently unknown.

Six-month follow-up of Iranian women in methadone treatment: drug use, social functioning, crime, and HIV and HCV seroincidence

BackgroundIn general, information about women who use drugs comes from studies performed in the West. Whether women in countries such as Iran are likely to enter drug treatment or how they will respond is not known.PurposeTo examine the short-term impact of methadone maintenance treatment (MMT) on drug use, dependence, social functioning, crime, and human immunodeficiency virus (HIV) and hepatitis C virus (HCV) risk behavior and seroincidence in female drug users in Iran.MethodsWomen were eligible for inclusion in the study if they were assessed as dependent on opiates according to the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10). The sample comprised 78 female heroin or opium users who attended the Persepolis women’s drug treatment clinic in Tehran between 2007 and 2008. Participants were followed up in 2009/2010. Heroin and the use of other drugs, social functioning, involvement in crime, and involvement in HIV and HCV risk behavior were measured by self-report. The prevalence and incidence of HIV and HCV were measured by serology and self-report.FindingsOf the 78 women recruited, 40 were followed up, and this occurred approximately 7 months later. One in four women reported a history of drug injection. At follow-up there were significant reductions in self-reported heroin use on ICD-10 dependence scores. Subjects with more severe drug dependence at baseline were significantly more likely to be criminally active than less severely dependent subjects. Baseline prevalence for HIV and HCV was 5% and 24%, respectively. At follow-up, no one had acquired HIV infection, but one participant had acquired HCV, giving an incidence rate of 7.1 per 100 person-years.ConclusionThis research provides the first evidence that Iranian female drug users can enter MMT and respond well. Within a few months of entering MMT, improvements occurred in heroin use, levels of dependence, social functioning, and HIV risk behavior. While the incidence of blood-borne viral infections was low, there was a serious risk of HIV transmission among this cohort and also to participants’ needle and sexual contacts. In a country with high levels of drug use, the high levels of HCV among female drug users require more women to enter drug treatment if an HIV epidemic is to be avoided. Many participants had a chronic drug problem and had had little or no previous exposure to MMT. The introduction or expansion of women-only drug treatment services is urgently needed in order to engage more women in treatment.

Duffy-null-associated low neutrophil counts influence HIV-1 susceptibility in high-risk South African black women.

The Duffy-null trait and ethnic netropenia are both highly prevalent in Africa. The influence of pre-seroconversion levels of peripheral blood cell counts (PBCs) on the risk of acquiring human immunodeficiency virus (HIV)-1 infection among Africans is unknown. The triangular relationship among pre-seroconversion PBC counts, host genotypes, and risk of HIV acquisition was determined in a prospective cohort of black South African high-risk female sex workers. Twenty-seven women had seroconversion during follow-up, and 115 remained HIV negative for 2 years, despite engaging in high-risk activity. Pre-seroconversion neutrophil counts in women who subsequently had seroconversion were significantly lower, whereas platelet counts were higher, compared with those who remained HIV negative. Comprising 27% of the cohort, subjects with pre-seroconversion neutrophil counts of <2500 cells/mm(3) had a ∼3-fold greater risk of acquiring HIV infection. In a genome-wide association analyses, an African-specific polymorphism (rs2814778) in the promoter of Duffy Antigen Receptor for Chemokines (DARC -46T > C) was significantly associated with neutrophil counts (P = 7.9 × 10(-11)). DARC -46C/C results in loss of DARC expression on erthyrocytes (Duffy-null) and resistance to Plasmodium vivax malaria, and in our cohort, only subjects with this genotype had pre-seroconversion neutrophil counts of <2500 cells/mm(3). The risk of acquiring HIV infection was ∼3-fold greater in those with the trait of Duffy-null-associated low neutrophil counts, compared with all other study participants. Pre-seroconversion neutrophil and platelet counts influence risk of HIV infection. The trait of Duffy-null-associated low neutrophil counts influences HIV susceptibility. Because of the high prevalence of this trait among persons of African ancestry, it may contribute to the dynamics of the HIV epidemic in Africa.