AIDS Cases Research Articles

A Descriptive Study of the Hearing of HIV Positive Individuals

Acquired Immunodeficiency Syndrome (HIV/AIDS) is caused by the human immunodeficiency virus (HIV/AIDS) and results in reduced immunity, which makes the persons more susceptible to numerous occasional infections and diseases due to low immunity, which requires attention regarding the use of ototoxic drugs, as in the case of tuberculosis. Ministry of Health’s data shows 592.914 AIDS cases registered in the country from 1980 until June 2010. Only in the year 2009, there were 38.538 reported cases across the country, accounting to an incidence rate of about 20 cases of AIDS per 100,000 inhabitants.

Transmitted Drug Resistance among People Living with HIV/Aids at Major Cities of Sao Paulo State, Brazil

Human immunodeficiency virus type 1 (HIV-1) transmitted drug resistance (TDR) is an important public health issue. In Brazil, low to intermediate resistance levels have been described. We assessed 225 HIV-1 infected, antiretroviral naïve individuals, from HIV Reference Centers at two major metropolitan areas of Sao Paulo (Sao Paulo and Campinas), the state that concentrates most of the Brazilian Aids cases. TDR was analyzed by Stanford Calibrated Population Resistance criteria (CPR), and mutations were observed in 17 individuals (7.6%, 95% CI: 4.5%–11.9%). Seventy-six percent of genomes (13/17) with TDR carried a nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance mutation, mostly K103N/S (9/13, 69%), potentially compromising the preferential first-line therapy suggested by the Brazilian HIV Treatment Guideline that recommends efavirenz-based combinations. Moreover, 6/17 (35%) had multiple mutations associated with resistance to one or more classes. HIV-1 B was the prevalent subtype (80%); other subtypes include HIV-1 F and C, mosaics BC, BF, and single cases of subtype A1 and CRF02_AG. The HIV Reference Center of Campinas presented more cases with TDR, with a significant association of TDR with clade B infection (P < 0.05).

Factors associated with mother‐to‐child transmission of the human immunodeficiency virus in Pernambuco, Brazil, 2000–2009

To identify risk factors associated with mother-to-child transmission of HIV in the Brazilian state of Pernambuco. Retrospective cohort study with 1200 HIV-exposed children born in Pernambuco, registered up to the age of 2months in a public programme to prevent vertical transmission. Univariate and multivariate logistic regression analyses were conducted for maternal and peripartum characteristics and prophylactic interventions, to identify risk factors for mother-to-child transmission of HIV. The transmission rate was 9.16% (95% CI: 7.4-10.9). The following risk factors were independently associated with transmission: non-use of antiretroviral during pregnancy (OR: 7.8; 95% CI: 4.1-15); vaginal delivery (OR: 2.02; 95% CI: 1.2-3.4); prematurity (OR: 2.5; 95% CI: 1.3-4.7); and breastfeeding (OR: 2.6; 95% CI: 1.4-4.6). This mother-to-child transmission rate is unacceptably high, as prophylactic interventions such as antiretroviral therapy and infant feeding formula are free of charge. Absence of antiretroviral therapy during pregnancy was the main risk factor. Therefore, early identification of exposed mothers and initiating prophylactic interventions are the main challenges for controlling transmission.

Evolution of HIV incubation times in AIDS patients

Since introduction of highly active antiretroviral therapy (HAART), the incidence of AIDS has gradually declined, although the incidence of HIV infection is largely unknown. We have studied a sample with 10,571 patients whose data were recorded by Spain's public health system, in the Andalusian Register of Cases of AIDS. The diagnoses correspond to the period January 1981 to June 2008. For this period, AIDS incubation times were analyzed by means of the survival and risk functions, using R survival and DTDA libraries. We have studied the evolution of incubation mean times according to specific variables from database. The obtained results show that the mean times of viral incubation presented a growing trend that was greater among women when the study was limited to heterosexual transmission. Stratifying by category of transmission, the longest incubation period was seen for intravenous drug users (IDU). Both gender and IDU transmission were associated with significantly greater survival without AIDS. In contrast, heterosexual transmission or pneumonia diagnosis were associated with lower survival without AIDS.

HIV and AIDS in the European Union, 2011

In 2011, a total of 28,038 new HIV diagnoses were reported by European Union and European Economic Area countries. The annual rate of HIV diagnoses does not show clear signs of decrease and HIV continues to be concentrated in selected populations such as men who have sex with men and injecting drug users, and a high proportion reported as late presenters. Despite effective and available antiretroviral treatment, the number of AIDS cases increased in a few countries.

Mortality and Treatment Outcomes of China's National Pediatric Antiretroviral Therapy Program

The aim of this study was to describe 3-year mortality rates, associated risk factors, and long-term clinical outcomes of children enrolled in China's national free pediatric antiretroviral therapy (ART) program. Records were abstracted from the national human immunodeficiency virus (HIV)/AIDS case reporting and national pediatric ART databases for all HIV-positive children ≤15 years old who initiated ART prior to December 2010. Mortality risk factors over 3 years of follow-up were examined using Cox proportional hazards regression models. Life tables were used to determine survival rate over time. Longitudinal plots of CD4(+) T-cell percentage (CD4%), hemoglobin level, weight-for-age z (WAZ) score, and height-for-age z (HAZ) score were created using generalized estimating equation models. Among the 1818 children included in our cohort, 93 deaths were recorded in 4022 child-years (CY) of observed time for an overall mortality rate of 2.31 per 100 CY (95% confidence interval [CI], 1.75-2.78). The strongest factor associated with mortality was baseline WAZ score <-2 (adjusted hazard ratio [HR] = 9.1; 95% CI, 2.5-33.2), followed by World Health Organization stage III or IV disease (adjusted HR = 2.4; 95% CI, 1.1-5.2), and hemoglobin <90 g/L (adjusted HR = 2.2; 95% CI, 1.2-3.9). CD4%, hemoglobin level, WAZ score, and HAZ score increased over time. Our finding that 94% of children engaged in this program are still alive and of improved health after 3 years of treatment demonstrates that China's national pediatric ART program is effective. This program needs to be expanded to better meet treatment demands, and efforts to identify HIV-positive children earlier must be prioritized.

Bisexuality and HIV risk: experiences in Canada and the United States.

The human immunodeficiency virus (HIV) epidemic has presented unparalleled challenges to sex researchers. Investigators have sought to understand a range of sexual behaviors and have scrutinized their roles in disease transmission. Opportunities have also emerged for developing and evaluating large-scale behavioral interventions to facilitate sexual risk reduction. In this article we examine a topic of interest to sex researchers and HIV prevention programs namely the relationship between bisexual behavior and HIV risk. We have gathered the theoretical and empirical literatures from two countries Canada and the United States permitting us to describe diverse experiences in countries in which variations in demographics and social norms as well as prevention programs may have consequences for the prevalence and contexts of bisexual behavior and for HIV risk. We begin our article with a review of the theories of bisexual behavior and a critique of methods used to study these populations. These sections provide a foundation for interpreting the empirical literature and for understanding the limitations of research related to HIV risk. We then provide for each country and for each gender a brief overview of data on the prevalence of bisexual behavior HIV prevalence and AIDS cases and the prevalence and determinants of HIV risk behaviors. We also review the emerging findings on prevention approaches for each population. Our review ends with a synthesis of the data across countries and genders and a proposed research agenda to increase our understanding of bisexual behavior and HIV risk among men and women who engage in sexual behavior with both genders. (excerpt)

HIV Prevalence Overall and among High-HIV-Risk Behaviorally Defined Subgroups among Heterosexuals at Community-Based Venues in a Mid-Atlantic, US City

A clear understanding of local transmission dynamics is a prerequisite for the design and implementation of successful HIV prevention programs. There is a tremendous need for such programs geared towards young African-American women living in American cities with syndemic HIV and injection drug use. In some of these American cities, including Baltimore, the HIV prevalence rate among young African-American women is comparable to that in some African nations. High-risk heterosexual sex, i.e., sex with an injection drug user or sex with someone known to have HIV, is the leading risk factor for these young women. Characterizing transmission dynamics among heterosexuals has been hampered by difficulty in identifying HIV cases in these settings. The case identification method described in this paper was designed to address challenges encountered by previous researchers, was based on the Priorities for Local AIDS Cases methodology, and was intended to identify a high number of HIV cases rather than achieve a representative sample (Weir et al., Sex Transm Infect 80(Suppl 2):ii63-8, 2004. Through a three-phase process, 87 venues characterized as heterosexual sex partner meeting sites were selected for participant recruitment in Baltimore, MD. One thousand six hundred forty-one participants were then recruited at these 87 venues, administered a behavioral risk questionnaire, and tested for HIV. The HIV prevalence was 3% overall, 3% among males, and 4% among females and ranged from 1.7 to 22.6% among high-HIV-risk subgroups. These findings indicate that attributing HIV transmission to high-risk heterosexual sex vs. other high-HIV-risk behaviors would be difficult. Moving beyond individual risk profiles to characterize the risk profile of venues visited by heterosexuals at high risk of HIV acquisition may reveal targets for HIV transmission prevention and should be the focus of future investigations.

Lung cancer in HIV‐infected patients

PurposeSeveral studies have shown that HIV patients are at higher risk of lung cancer. Our aim is to analyse the prevalence and features of lung cancer in HIV-infected patients.MethodsThe clinical charts of 4,721 HIV-infected patients seen in three hospitals of southeast Spain (study period 1992–2012) were reviewed, and all patients with a lung cancer were analysed.ResultsThere were 61 lung cancers, giving a prevalence of 1.2%. There was a predominance of men (82.0%), and smokers (96.6%; mean pack-years 35.2), with a median age of 48.0 (41.7–52.9) years, and their distribution according to risk group for HIV was: intravenous drug use 58.3%, homosexual 20.0%, and heterosexual 16.7%. Thirty-four (56.7%) patients were Aids cases, and 29 (47.5%) had prior pulmonar events: tuberculosis 16, bacterial pneumonia 9, and P. jiroveci pneumonia 4. The median nadir CD4 count was 149/mm3 (42–232), the median CD4 count at the time of diagnosis of the lung cancer was 237/mm3 (85–397), and 66.1%<350/mm3. 66.7% were on ART, and 70% of them had undetectable HIV viral load. The most common histological types of lung cancer were adenocarcinoma and epidermoid, with 24 (40.0%) and 23 (38.3%) cases, respectively. There were 49 (80.3%) cases with advanced stages (III and IV) at diagnosis. The distribution of treatments was: only palliative 23 (39.7%), chemotherapy 14 (24.1%), surgery and chemotherapy 8 (13.8%), radiotherapy 7 (12.1%), surgery 4 (6.9%), and other combined treatments 2 (3.4%). Forty-six (76.7%) patients died, with a median survival time of 3 months. The Kaplan-Meier survival rate at 6 months was 42.7% (at 12 months 28.5%).ConclusionsThe prevalence of lung cancer in this cohort of HIV-patients is high. People affected are mainly men, smokers, with transmission of HIV by intravenous drug use, and around half of them with prior opportunistic pulmonary events. Most patients had low nadir CD4 count, and were immunosuppressed at the time of diagnosis. Adenocarcinoma is the most frequent histological type. The diagnosis is usually made at advanced stages of the neoplasm, and mortality is high.

Iron overload, an immunosuppression marker in HIV‐infected patients

PurposeIron overload (IO) has been associated with increased cardiovascular risk (CVR) and metabolic syndrome (MS) in the general population; both elevated CVR and MS are frequent in HIV‐patients. Our aim was to analyze the prevalence of IO in a cohort of asymptomatic patients with HIV infection, and related factors.MethodsCross‐sectional study of a cohort of HIV outpatients in regular follow‐up. Demographic, epidemiological, clinical, analytical and therapeutic data were collected. Patients completed a questionnaire about CVR factors and 10‐year CV disease risk estimation (Framingham score), underwent a physical exam, and a fasting blood analysis. IO was defined as a plasma ferritin level higher than 200 μ/L in women and 300 μ/L in men.Results571 patients (446 men, 125 women), with a mean age of 43.2 years, sexual transmission of HIV in 68.5%, median CD4 count 474 cell/μL (IQR: 308–666), and 36.3% Aids cases. 86.2% were on antiretroviral therapy (ART), and 74.8% of them had undetectable HIV viral load. 14.6% met MS criteria, and mean CVR at 10 years was 6.67%. IO was detected in 11% of cases. Patients with IO were more immunosuppressed (CD4 count 369 vs 483/μL, p&lt;0.0001), presented a higher prevalence of detectable HIV viral load (17.6% vs 8.9%; p&lt;0.005), and of Aids cases (14.9% vs 8.7%; p&lt;0.023), and lower plasma levels of cholesterol, HDLc and LDLc (154 vs 183, 34 vs 43, 93 vs 110 mg/dL, respectively; p&lt;0.0001. In the multivariate analysis, the only related factor was CD4 count &lt;350 cell/μL (OR 2.86, 95% CI 1.6–4.9; p&lt;0.0001). IO was not associated with CVR nor with MS.ConclusionsIO is not uncommon in HIV patients, and it is only related with immunosuppression defined as CD4 count &lt;350 cell/μL, and in contrast to general population, it is not related with increased CVR nor with MS.

Prevalence of HIV 2: A retrospective study from a HIV/AIDS consult

The western Africa is the origin of the HIV2 infection where Guinea Bissau has been the country where the rate of infection is higher. This infection have extended to Europe through the relationship established between European countries and there African colonies in the past. At 2010, 1.295 cases of HIV 2 infection were notified in Portugal, which represents nearly 3.3% of all HIV infections. Almost 510 of these cases are classified as AIDS. Although the majority of notified cases is from African patients there is still a significant contribution of the Portuguese people in these numbers. Retrospective analysis of HIV2 infected women and men followed at Faro's Hospital HIV/AIDS consult between January 1992 and June 2012. In this sample were included every patient older than 15 years and were excluded every patient than haven't been at the consult for a period superior to 18–24 months. Deceased patients and address change were also exclusion factors. Of all 1500 patients followed in consult, 35 of them were infected with HIV2 (2.3%); 18 women and 17 men. There were 3 patients that were co‐infected with HIV1 and HIV2. Mean age were 52.9 years. 19 of the infected patients were leucodermic and 16 were melanodermic. The majority of patients (19 cases) were Portuguese. The rest of them were from Africa where Guinea Bissau were the only country represented. In opposition to the HIV1 infection, the sexual transmission is by far the more common way of being infected. There's no case of vertical transmission known in our population. At the first contact, the majority of patients appear asymptomatic (16 cases) while a minority (4 cases) manifest themselves by AIDS. There is an AIDS case that result from HIV1 and HIV2 co‐infection (only one intravenous drug user in the group). The more common treatment is the association of NRTI and PI. The HIV2 infection is characterized by a longer clinical evolution when compared to the HIV1 infection. That fact explains why the mean age of patients is higher in the first case. This study shows that there isn't a gender incidence difference between men and women. Despite what happens at a national level, at local level the HIV2 infection is more prevalent among patients born in Portugal. It's important to notice that the HIV1 and HIV2 co‐infection is rising and that leads to some questions like viral synergism with consequent rapid disease progression.

Bone turnover markers in HIV‐infected patients before starting antiretroviral therapy

PurposeBone turnover markers (BTM) ‐ aminoterminal propeptide of type 1 collagen (P1NP) and C‐terminal telopeptide of type 1 collagen (β‐CTX) ‐ are related to bone density and fracture risk. A high prevalence of osteopenia/osteoporosis and hypovitaminosis D has been reported in HIV patients, however there are few data about BTM in this population. Our aim was to analyse the prevalence of elevated serum levels of BTM in HIV patients before starting antiretroviral therapy (ART), and related factors.MethodsCross‐sectional study of a series of HIV‐patients who started ART during June/11–June/12 in our hospital. Patients with presence of diseases or treatments known to affect bone metabolism were excluded. Epidemiological, clinical, and immunovirological data in addition to serum fasting levels of glucose, lipid profile, calcium, phosphate, alkaline phosphatase, 25‐hydroxyvitamin D3 (25OHD), parathyroid hormone (PTH), P1NP, and β‐CTX were collected. Definitions: hypovitaminosis D if 25OHD&lt;30 ng/ml, vitamin D deficiency if 25OHD&lt;20 ng/ml; elevated levels of BTM if β‐CTX (ng/ml) &gt;0.64 (men&lt;70 years),&gt;0.85 (men &gt;70 years),&gt;0.58 (pre‐menopause women), &gt;0.99 (post‐menopause women), or P1NP (ng/mL)&gt;69.4 (men &lt;60 years), &gt;71.1 (men&gt;60 years), &gt;55.7 (pre‐menopause women), &gt;61.2 (post‐menopause women).Results47 patients were included, 91.5% men, median age 37.1 years (30.0–44.3), and 93.6% sexual transmission of HIV (34 HMX, 10 HTX). Median time since the diagnosis of HIV was 3.4 months (1.4–31.7); there were 7 (14.9%) Aids cases, median CD4 count was 277/mm3 (155–433), and HIV‐VL 4.8 log10 (4.1–5.2). Median serum 25OHD was 29 µg/L (21.9–41.1), with a prevalence of hypovitaminosis of 52.2%, and deficiency of 17.4%. PTH was in range in all cases. Median serum P1NP was 33.3 ng/mL (24.5–52.5) and β‐CTX 0.25 ng/mL (0.20–0.45); five (11.4%) patients presented high levels of BTM: 4 men, median age 37.1 years, median CD4 count 247/mm3, median HIV‐VL 5.18 log10, and one with hypovitaminosis D. Elevated BTM were related with no clinical, analytical, immunovirological parameters nor with serum levels of 25OHD nor PTH.ConclusionsThe prevalence of elevated BTM was high in this series of HIV‐patients, mostly young men, with short time of HIV infection and with no immunovirologic control. BTM were related with no clinical nor analytical data.

A new scale-free network model for simulating and predicting epidemics

The course of epidemics often resembles a scale-free network, but some specific elements should be considered in developing a new model. This study introduces a time-shifting and discontinuous forcing function H into the scale-free network model to fit the specific period and intensity of the infection, and redefines the probability p as abortive infection rate. For the non-human vectors or hosts, three new factors (new connectivity Ki(t), new links M, and time delay τ) were introduced in the proposed model of this study. The simulation results of six types of epidemic transmissions show that the proposed Scale-Free Epidemic Models, SFE-1 and SFE-2, are accurate. SFE-1 model and SFE-2 model are useful for the transmission categories from human and insects/vertebrates, respectively. Further comparisons of different races/ethnicities and different transmission categories of AIDS cases in the United States were also analyzed. Both SFE models can be used to predict epidemics and can suggest the results more clearly, irrespective of whether the epidemics are under control. Therefore, the proposed SFE models can help the government determine the level of caution required and predict the results of policy decisions, thus helping to balance socioeconomic and health concerns.

Emerging HIV Epidemic Among Older Adults in Nanning, China

The HIV/AIDS surveillance data indicates that the proportion of people living with HIV/AIDS (PLWHAs) who were 50 years old or older increased to 42.7% in 2011 from 16.5% in 2007 in Nanning, the capital city of Guangxi Province. A greater number of newly diagnosed HIV cases compared to clinical AIDS cases were identified from older adults. The dominant HIV transmission mode among older PLWHAs was heterosexual although approximately 30% of all PLWHAs acquired HIV through heterosexual contacts.

Resurgence of HIV Infection among Men Who Have Sex with Men in Switzerland: Mathematical Modelling Study

BackgroundNew HIV infections in men who have sex with men (MSM) have increased in Switzerland since 2000 despite combination antiretroviral therapy (cART). The objectives of this mathematical modelling study were: to describe the dynamics of the HIV epidemic in MSM in Switzerland using national data; to explore the effects of hypothetical prevention scenarios; and to conduct a multivariate sensitivity analysis.Methodology/Principal FindingsThe model describes HIV transmission, progression and the effects of cART using differential equations. The model was fitted to Swiss HIV and AIDS surveillance data and twelve unknown parameters were estimated. Predicted numbers of diagnosed HIV infections and AIDS cases fitted the observed data well. By the end of 2010, an estimated 13.5% (95% CI 12.5, 14.6%) of all HIV-infected MSM were undiagnosed and accounted for 81.8% (95% CI 81.1, 82.4%) of new HIV infections. The transmission rate was at its lowest from 1995–1999, with a nadir of 46 incident HIV infections in 1999, but increased from 2000. The estimated number of new infections continued to increase to more than 250 in 2010, although the reproduction number was still below the epidemic threshold. Prevention scenarios included temporary reductions in risk behaviour, annual test and treat, and reduction in risk behaviour to levels observed earlier in the epidemic. These led to predicted reductions in new infections from 2 to 26% by 2020. Parameters related to disease progression and relative infectiousness at different HIV stages had the greatest influence on estimates of the net transmission rate.Conclusions/SignificanceThe model outputs suggest that the increase in HIV transmission amongst MSM in Switzerland is the result of continuing risky sexual behaviour, particularly by those unaware of their infection status. Long term reductions in the incidence of HIV infection in MSM in Switzerland will require increased and sustained uptake of effective interventions.

HIV/AIDS Projection in TamilNadu using back calculation method

The current prevalence of HIV infection and the corresponding pattern of incidence from the beginning of the epidemic to the present time are mainly estimated by means of back-calculation method. This back-calculation method reconstructs the past pattern of HIV infection and predicts the future number of AIDS cases with the present infection status. The basic data required for back-calculation methodology is the number of AIDS cases over a period of time. TANSACS publishes the reported number of AIDS cases in Tamil Nadu. In this paper, the various approaches for modeling the incubation distribution are compared using real data under various infection density distributions. The projected minimum and maximum AIDS cases in Tamil Nadu, a southern state of India, based on the reported data are 3702712 and 6936047 respectively. These estimates are based on the unadjusted AIDS incidence data. The purpose of this paper is to review the contribution of back-calculation method to our understanding of the AIDS and to summarize and interpret the epidemiological findings. Keywords: HIV/AIDS, Incubation period, Estimation, Infection distributions, Back calculation

HIV/AIDS Projection in Tamilnadu Using Back Calculation Method

The current prevalence of HIV infection and the corresponding pattern of incidence from the beginning of the epidemic to the present time are mainly estimated by means of back-calculation method. This back-calculation method reconstructs the past pattern of HIV infection and predicts the future number of AIDS cases with the present infection status. The basic data required for back-calculation methodology is the number of AIDS cases over a period of time. TANSACS publishes the reported number of AIDS cases in Tamil Nadu. In this paper, the various approaches for modeling the incubation distribution are compared using real data under various infection density distributions. The projected minimum and maximum AIDS cases in Tamil Nadu, a southern state of India, based on the reported data are 3702712 and 6936047 respectively. These estimates are based on the unadjusted AIDS incidence data. The purpose of this paper is to review the contribution of back-calculation method to our understanding of the AIDS and to summarize and interpret the epidemiological findings.

The Europeanization of Public Health: How Does It Work? The Seminal Role of the AIDS Case

This article analyzes the path that led the European Union from a somewhat accidental involvement in fighting AIDS to a new and sustainable policy of communicable disease control. It responds to three main questions: Why did an unexpected case lead to the organization of a new sustainable policy? How was this achieved despite national competency over the given policy sector? How did the new policy succeed in covering the enlarged EU? The explanation combines political factors and public health issues. European integration and eastern enlargement made transborder disease management a political necessity. Treaties gave legitimacy to EU policy, while the AIDS matrix furnished the practical procedures: networking, data harmonization, peer-conducted policy coaching, and participation. This pattern of public health management is compatible with national competency, and it is consistent with the democratic values the EU promotes throughout and beyond the enlarged EU. From a theoretical point of view, these patterns of activities constitute the empirically grounded content of the much used but less defined concept of cognitive Europeanization.

Clinical, epidemiological and molecular features of the HIV-1 subtype C and recombinant forms that are circulating in the city of São Paulo, Brazil

BackgroundThe city of Sao Paulo has the highest AIDS case rate, with nearly 60% in Brazil. Despite, several studies involving molecular epidemiology, lack of data regarding a large cohort study has not been published from this city.ObjectivesThis study aimed to describe the HIV-1 subtypes, recombinant forms and drug resistance mutations, according to subtype, with emphasis on subtype C and BC recombinants in the city of São Paulo, Brazil.Study designRNA was extracted from the plasma samples of 302 HIV-1-seropositive subjects, of which 211 were drug-naive and 82 were exposed to ART. HIV-1 partial pol region sequences were used in phylogenetic analyses for subtyping and identification of drug resistance mutations. The envelope gene of subtype C and BC samples was also sequenced.ResultsFrom partial pol gene analyses, 239 samples (79.1%) were assigned as subtype B, 23 (7.6%) were F1, 16 (5.3%) were subtype C and 24 (8%) were mosaics (3 CRF28/CRF29-like). The subtype C and BC recombinants were mainly identified in drug-naïve patients (72.7%) and the heterosexual risk exposure category (86.3%), whereas for subtype B, these values were 69.9% and 57.3%, respectively (p = 0.97 and p = 0.015, respectively). An increasing trend of subtype C and BC recombinants was observed (p < 0.01).ConclusionThe HIV-1 subtype C and CRFs seem to have emerged over the last few years in the city of São Paulo, principally among the heterosexual population. These findings may have an impact on preventive measures and vaccine development in Brazil.

Engaging to End the Epidemic

Engaging to End the Epidemic