Blood For HIV Testing Research Articles

Validation study of a conventional enzyme immunoassay to detect HIV antibodies in oral fluid

The aim of our study was to validate the Genscreen HIV ½ version 2 (BIO-RAD) for detecting HIV antibodies in oral fluid specimens (OF). The advantage of assays to detect HIV infection in OF lies in the on-site easy access and noninvasive sample collection. Paired serum and OF were collected from 496 subjects (263 HIV-positive and 233 HIV-negative) using the Oracol test kit (Oracle Diagnostics, Inc). The quality of OF was verified by measuring total IgGs using the Human IgG ELISA Quantitation Kit (Bethyl Lab.inc). All reactive OF samples were retested by Western blot HIV1/2 BLOT 2.2 (MP Biomedical, Singapore, China). Of 263 OF samples from participants with blood-based HIV-positive results, 259 were positive by Genscreen HIV ½ version 2 (98.48% sensitivity, 95% CI; 96.2-99.6). The 233 individuals who had a non-reactive HIV blood test were found negative on testing their OF by Genscreen HIV ½ version 2 (100% specificity, 95% CI; 98.4-100). NPV and PPV of the assay were 98.31% (95% CI; 95.74-99.34) and 100%, (95% CI; 98.53-100.00), respectively. Genscreen HIV ½ version 2 (Bio-Rad) is aprospective method for HIV surveillance studies in hard-to-reach populations with high risk behavior using non-invasive OF collection (Tab. 1, Fig. 1, Ref. 16).

Family practitioners screening for HIV infection

BackgroundWe assessed how family physicians screened for HIV infection in Paris, in 2013 and whether their practice had changed after publication of the HAS (French National Authority for Health) recommendation for systematic screening. MethodFamily practitioners (FPs) in Paris answered a questionnaire by e-mail or regular mail from January to April 2013. The statistical analysis was performed with the Chi2 test. ResultsFour hundred and seven FPs answered (77.8% response rate). FPs did not always identify risk cases: 78% in case of sexually transmitted infection, but 32% for partner change, 39% for patients from a highly HIV endemic country, and 21% for sexually active teenagers or adults. Practices differed according to districts. FPs in the 1st and in the Northeastern Paris districts detected risk cases for HIV more often than their colleagues, and they used screening more often, with, consequently, more frequently positive results. The screening strategies also differed according to the FPs’ demographic characteristics and their type of practice: young (P=0.0002) female (P=0.02) FPs working in “sector 1 (patients fully reimbursed)” (P=8.10−5) prescribed more HIV blood tests. Surprisingly, only 45% of FPs was aware of the recent recommendation for systematic screening of HIV. ConclusionThe Paris FP screening practices differ according to demographic characteristics, place, and type of practice. Screening practices have not changed since the publication of the new screening strategy.

Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: results of a consultation with community stakeholders.

BackgroundAs pre-exposure prophylaxis (PrEP) moves closer to availability in developing countries, practical considerations for implementation become important. We conducted a consultation with district-level community stakeholders experienced in HIV-prevention interventions with at-risk populations in Bondo and Rarieda, Kenya to generate locally grounded approaches to the future rollout of oral PrEP to four populations: fishermen, widows, female sex workers, and serodiscordant couples.MethodsThe 20 consultation participants represented the Ministry of Health, faith- and community-based organizations, health facilities, community groups, and nongovernmental organizations. Participants divided into breakout groups and followed a structured discussion guide asking them to identify barriers to implementing HIV-prevention interventions (including PrEP) with each population. Questions also solicited solutions for addressing these barriers, as well as other facilitators for PrEP implementation. In particular, questions focused on how to encourage people to screen for PrEP eligibility by having HIV and other blood tests and how to encourage compliance with ongoing HIV testing.ResultsThe barriers and facilitators/solutions discussants provided were frequently population-specific, but there were also broad-level similarities across populations. Service delivery barriers to HIV-prevention interventions concerned the need for staff trained to address the needs of particular populations. Service delivery facilitators to provision of ongoing HIV testing consisted of offering testing options besides facility-based testing. Stigma was the main community-level barrier for all groups, whereas barriers at the level of target populations included mobility; lifestyle and life circumstances, especially cultural norms among fishermen and widows; and fears, lack of awareness, and misinformation. Proposed facilitators and strategies for addressing community- and population-level barriers included topic-specific education within the populations and community, involvement of partners and family members, mass HIV testing, and peer educators. Barriers to PrEP uptake included non-adherence to pill taking and missing clinic visits. For drug adherence, facilitators were counselling and involving family members. Discussants suggested that client reminders, e.g., home visits, were needed to encourage clients to keep their clinic appointments.ConclusionsStrategies for encouraging eligibility screening and ongoing HIV testing will have local and population-specific aspects. Our results nonetheless apply to similar populations throughout sub-Saharan Africa and reach beyond oral PrEP to other ARV-based PrEP formulations.

Post-international adoption medical follow-up at the Angers university hospital between 2009 and 2012

ObjectiveThe authors had for aim to describe infectious diseases in internationally adopted child at arrival in France. Patients and methodsWe made a retrospective descriptive study of the children's files having undergone medical check-ups between 2009 and 2012. ResultsOne hundred and eighty-two files were included: 80% of the children came from Africa, 15% from South America and the Caribbean, 3% from Asia, and 2% from Europe. Forty-three percent were diagnosed with tinea. HIV, hepatitis C, and syphilis blood tests were all negative. Six children presented with acute or chronic hepatitis B, another 5 children with acute hepatitis A. One blood test for cysticercosis was positive. Two children presented with malaria. 58% of the children carried an intestinal parasite; the most prevalent was Giardia duodenalis. Bacteriological stool culture was positive for 17 children, for 9 with an antibiotic resistant bacterium. Twenty-seven children had a positive virological stool culture, 2 for a poliovirus. ConclusionA systematic infectious check-up should be performed for a child adopted internationally when he/she arrives in France. This allows diagnosing diseases requiring an emergency treatment, or asymptomatic but severe diseases when chronic. Some blood tests must be double-checked when the child arrives, because of possible false negative initial tests results in the country of origin. Screening, early treatment, and implementing prophylaxis can decrease the risk of transmission to relatives. It also allows monitoring the antimicrobial resistance of some pathogens and the reintroduction of the poliovirus in France.

Peripartum cardiomyopathy vs. sulprostone-associated heart failure? A case report and analysis of the literature

A 37-year-old Caucasian woman was referred for a planned cesarean section due to placenta preavia at 38 weeks. The patient has no significant personal history of disease, and was closely monitored throughout the pregnancy. Three hours after surgery, the patient developed postpartum hemorrhage requiring sulprostone administration for uterine atony. Eight hours after surgery, the patient had a sudden cardiogenic shock with biventricular failure requiring intensive care and infusion of noradrenaline (0.3 lg/kg/min) and dobutamine (20 lg/kg/min). Electrocardiography (ECG) showed sinus tachycardia (130 beats/ min) with normal conduction, without any ST segment changes. She desaturated from 91 to 60 % oxygen, the laboratory tests found anemia (Hb = 10.8 g/dL), both metabolic and respiratory acidosis (pH = 7.24; PCO2 = 39 mmHg; PO2 = 70 mmHg; HCO3 = 16.1 mmol/L; lactate = 2.1 mmol/L), no schistocytes, a very low haptoglobin (\0.10 g/L), and increased cardiac enzymes [CPK = 1209 UI/L; troponin = 1.29 lg/L (normal range \0.2 lg/L)]. A transthoracic echocardiography (TTE) found a severe biventricular dysfunction with a left ventricular ejection fraction (LVEF) between 25 and 30 %, without valvular lesion or pericardial effusion. This echocardiographic report was compatible with peripartum cardiomyopathy (PPCM). Chest X-ray showed bilateral diffuse alveolar syndrome. The patient improved rapidly and LVEF increased to 45 % 4 days later. All etiological exams were negative (Parvovirus, EBV, HHV6, CMV, HIV, Coxsackie, Enterovirus serologies, autoimmune thyroid and selenium blood test), and cardiac magnetic resonance imaging showed no evidence of inflammatory process, including any early gadolinium enhancement. The evolution was favorable, and the patient was discharged with long-term treatments (angiotensin-converting-enzyme inhibitors and b-blocking) 12 days later. She was re-evaluated 4 months later, all exams (TTE, biological tests, ECG) were normal and all treatments were stopped. PPCM is a serious dilated cardiomyopathy of unknown origin and occurs in less than 0.1 % of pregnancies, with high mortality rate ranging from 5 to 32 % [1–3]. This is usually a severe heart failure, with sudden onset, in previously healthy women in final month of pregnancy and up to 5 months after delivery. Strong associations have been shown between PPCM and older maternal age, hypertension, multiple pregnancies, and African American background, but precise mechanisms that lead to disease remain poorly defined [1–3]. Cases of major and brutal heart failure associated with sulprostone had been published, as cardiac arrest, pulmonary edema or Takotsubo cardiomyopathy [4–6]. There are few reported cases linking PPCM with the administration of sulprostone [7, 8]. One recently published case is particularly interesting and can support our hypothesis of possible association between PPCM and sulprostone [7]. A 37-year-old Asian woman underwent a cesarean delivery at 37 weeks for failed induction of labor with sulprostone administration for transient uterine atony. Two hours after surgery, heart failure with severe metabolic acidosis and elevated cardiac enzymes were observed requiring M. Vital G. Ducarme (&) Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France e-mail: g.ducarme@gmail.com

Time to roll out rapid testing for HIV? Yes, but with appropriate safeguards

In a study published in this edition of Sexual Health, Wilson et al. using mathematical modelling, suggest that individuals with primary HIV infection and those who are HIV infected but undiagnosed, contribute disproportionately to new HIV infections among men who have sex with men. Based on these findings, they make the case for increased HIV testing to increase rates of HIV diagnosis. The diagnosis of HIV has clear benefits for HIV infected individuals as well as the population. For the individual, early diagnosis provides the opportunity for appropriate patient management and initiation of antiretroviral therapy at an optimal point in time, which can now offer the expectation of a near normal life span. In contrast, those who are diagnosed late have much poorer health outcomes at significant health service cost. It is a disheartening reflection of current testing strategies that a substantial proportion of people newly diagnosed with HIV still present at an advanced stage in their infection. In the UK, 31% of people newly diagnosed with HIV first present for testing when their CD4 count is less than 200. At the population level, early detection of HIV contributes to improved HIV control by enabling partner notification and evidence suggests that individuals diagnosed with HIV usually alter their sexual behaviour so as to reduce the risk of further HIV transmission. The benefits from increased HIV detection would be greatest in populations where the proportion of undiagnosed individuals is highest. In 2003, there were an estimated 1million persons infected with HIV in the USA with one-quarter of these persons unaware of their status. In the UK it is estimated that of the 77 400 people with HIV, 28% of them are unaware of their infection. These data highlight a pressing need for new approaches to reduce barriers to testing. So how might testing for HIV be substantially increased? One way is through the use of rapid testing for HIV using either a finger prick blood sample or a sample of oral fluid obtained by a mouth swab with results available at the point of testing within minutes. The use of rapid HIV testing confers a number of potential benefits which may reduce barriers to testing. Rapid testing removes the typical 1–2 week delay between test and result with conventional HIV blood tests. This is important as it is not uncommon for clients to express anxiety about this waiting period and this may actually deter individuals from testing. Recent studies suggest that clients favour rapid HIV testing over conventional testing, citing the immediacy of results as the main factor behind this preference. 10 The provision of a result at the time of testing has the added advantage of preventing loss of patients to follow up. In the USA, 31% of people who tested HIV positive in 2000 did not return for their test result. However, the implementation of rapid testing in New York State in 2003 meant that 100% of those tested received their result and led to a 36% increase in testing over the previous year resulting in increased detection of previously undiagnosed HIV. A further advantage of rapid HIV tests is that they are ideally suited to non-clinical or community settings, providing access to HIV testing to individuals who might not otherwise access clinical services for testing. Oral fluid sampling may confer added benefits to users over finger prick blood testing as it may be perceived as less invasive and is less painful. Given that oral fluid is not considered potentially infectious unless it contains blood, the disposal of samples is also much easier. Many settings have been proposed as outreach sites including bars, clubs and saunas, further education and sports settings. However, we must recognise that individuals need a choice of venues for testing to include both community and clinic-based settings, as people vary greatly in their preferences. One sauna based UK study of men who have sex with men reported that some men would not feel comfortable testing for HIV in a club as they feared the consequences of receiving a positive result in that setting. Rapid testing appears popular with health care professionals. Moreover, after training and experience with rapid testing, counsellors without previous laboratory training have shown proficiency in rapid testing and express a preference for rapid testing over conventional testing. A number of rapid HIV tests have been approved for use by the US Food and Drug Administration (US FDA). Some of these have only been approved for use within the laboratory setting, whereas others can be administered outside laboratories by persons without formal laboratory training. The OraQuick ADVANCE Rapid HIV-1/2 Antibody Test (OraSure Technologies, Bethlehem, PA, USA) stands out as it can provide CSIRO PUBLISHING Editorial

Participation of traditional birth attendants in prevention of mother-to-child transmission of HIV services in two rural districts in Zimbabwe: a feasibility study

BackgroundPrevention of Mother-to-Child Transmission of HIV (PMTCT) is among the key HIV prevention strategies in Zimbabwe. A decrease in use of antenatal care (ANC) services with an increase in home deliveries is affecting the coverage of PMTCT interventions in a context of accelerated economic crisis. The main objective was to evaluate acceptability and feasibility of reinforcing the role of traditional birth attendants (TBAs) in family and child health services through their participation in PMTCT programmes in Zimbabwe.MethodsA community based cross-sectional survey was undertaken using multistage cluster sampling in two rural districts through interviews and focus group discussions among women who delivered at home with a TBA, those who had an institutional delivery and TBAs.Results45% of TBAs interviewed knew the principles of PMTCT and 8% delivered a woman with known HIV-positive status in previous year. Of the complete package of PMTCT services, more than 75% of TBAs agreed to participate in most activities with the exception of performing a blood test (17%), accompanying new-borns to closest health centre to receive medication (15%) and assisting health centres in documentation of the link ANC-PMTCT services (18%). Women who delivered at home were less likely to have received more than one ANC service or have had contact with a health centre compared to women who delivered in a health centre (91.0% vs 72.6%; P < 0.001). Also, 63.6% of the women who delivered in a health centre had the opportunity to choose the place of delivery compared to 39.4% of women who delivered at home (P < 0.001). More than 85% of women agreed that TBAs could participate in all activities related to a PMTCT programme with the exception of performing a blood test for HIV. Concerns were highlighted regarding confidentiality of the HIV-serostatus of women.ConclusionAlthough the long-term goal of ANC service delivery in Zimbabwe remains the provision of skilled delivery attendance, PMTCT programmes will benefit from complementary approaches to prevent missed opportunities. TBAs are willing to expand their scope of work regarding activities related to PMTCT. There is a need to reinforce their knowledge on MTCT prevention measures and better integrate them into the health system.

Feasibility of infant cord blood HIV testing for anti-retroviral post-exposure prophylaxis

Many maternity hospitals in developing country settings deliver women who are of unknown HIV status. The main objectives of this study were to evaluate the acceptability of post-partum infant cord blood HIV testing and the subsequent uptake of interventions to prevent mother-to-child transmission of HIV. This was a cross-sectional study among infants delivered to women of unknown HIV status at the maternity ward of the Kenyatta National hospital, Kenya. At the time of delivery, five milliliters of cord blood was collected from consecutive singleton-birth infants born to women with unknown HIV status. After delivery, the women were counseled and consent was sought for HIV antibody testing of the cord blood. Anti-retroviral post-exposure prophylaxis was provided for HIV exposed infants and their mothers counseled on infant feeding. Overall 220 (87%) of the 253 mothers gave consent for HIV testing. This included 35 (90%) of 40 mothers of babies with HIV positive cord blood and 184 (86.4%) of 213 with HIV negative cord blood. Seventeen (48.6%) of the 35 women who knew their status accepted to administer anti-retroviral prophylaxis to their infants, and 28 (80%) chose to breast-feed their infants. Infant cord blood testing is highly acceptable among women who deliver with an unknown HIV status and provides an additional entry point for prevention of mother-to-child transmission of HIV.

Test Not Talk screening for asymptomatic men

This audit reviews the first year's experience within a rapid comprehensive sexually transmitted infection (STI) and HIV screening for asymptomatic men in a small-integrated sexual health clinic in outer London. Men requesting STI/HIV screening only were offered symptom self-assessment, blood tests for syphilis and HIV, and first void urine tests for chlamydia and gonorrhoea. Of 468 available appointments, 337 were made (72%) and 303 were kept (80%). Of the 303 attendances, 264 (87%) were first-ever attendances. Of the 303 men seen, 295 (97.4%) underwent chlamydia and gonorrhoea testing, while 246 (80.9%) were tested for syphilis and HIV. No new HIV diagnoses were made. One patient was diagnosed with late latent syphilis and one had asymptomatic gonorrhoea, while 20 (6.6%) diagnoses of chlamydia were made. We believe that Test Not Talk clinics offer a good approach to rapid screening of asymptomatic men and to meet their sexual health needs.

Dos enfermedades relacionadas con el VHH-8 en un paciente VIH-negativo: sarcoma de Kaposi y enfermedad de Castleman multicéntrica. Respuesta a tratamiento con rituximab y CHOP

Human herpes virus 8 (HHV8) was discovered in 1994 in the biopsy of a Kaposi's sarcoma in a patient with AIDS. Since then it has been identified in all variants of Kaposi's sarcoma and in another two rare disorders: multicentric Castleman's disease and primary body-cavity based lymphomas. The case discusses a 68 year old, HIV-negative male patient, presenting Kaposi's sarcoma for one year and being monitored by dermatology, who presented for weakness, anorexia and fever. On examination, he was found to have adenitis of the lymph nodes in his neck, underarm and groin. A biopsy on one of the swellings led to findings characteristic of multicentric plasma cell variant Castleman's disease. Blood tests for HHV8 and HIV were carried out, resulting positive and negative respectively (IgG anti-HHV8 positive, title 1/640, indirect immunofluorescence). PCR amplification showed HHV8 in peripheral blood. Patient received 8 cycles of CHOP and rituximab, leading to complete disappearance of the adenitis and general symptoms, with no worsening of his Kaposi's sarcoma. Patient remained in complete remission for 10 months after treatment. This paper discusses the case of a HIV-, HHV8+ patient, diagnosed with classic Kaposi's sarcoma, who developed multicentric plasma cell variant Castleman's disease. The coincidence of two or more HHV8-related illnesses in a HIV-negative patient has rarely been described in medical literature. Treatment with rituximab combined with CHOP chemotherapy was effective in this case, and no worsening of the patient's KS was observed.

HIV and AIDS: 20 years of science.

From the identification of HIV as the agent that causes AIDS, to the development of effective antiretroviral drugs, the scientific achievements in HIV research in the past 20 years have been formidable. Some of the other important areas of accomplishment include the development of blood tests for HIV and increased knowledge of the molecular virology, epidemiology and pathogenesis of this virus.

Detecção de Doenças Sexualmente Transmissíveis em Clínica de Planejamento Familiar da Rede Pública no Brasil

Objetivo: analisar a prevalência da gonorréia, infecção por clamídia, sífilis e infecção por HIV entre as mulheres de uma clínica de planejamento familiar em função da presença de sintomas de DST e de comportamentos de risco. Métodos: mulheres com as idades entre 18 e 30 anos que freqüentavam os serviços de uma clínica de planejamento familiar da rede pública no Brasil foram testadas para a gonorréia e infecção por clamídia, com o uso do teste de amplificação do DNA na urina, para a sífilis e a infecção por HIV por meio de exames de sangue. Foram feitas a todas as participantes perguntas sobre comportamento de demanda de serviços de saúde, a presença de sintomas de DST e comportamentos de risco para as doenças sexualmente transmissíveis. Resultados: a infecção por clamídia foi encontrada em 11,4%, a sífilis em 2%, a gonorréia em 0,5% e a infecção por HIV em 3%. Aproximadamente 60% das mulheres que estavam infectadas por clamídia não apresentavam sintomas. Mulheres que nunca usavam preservativos apresentaram um risco de DST muito mais alto do que aquelas que sempre ou na maioria das vezes usavam preservativos. Houve tendência para as mulheres que nunca haviam feito uso de qualquer método anticoncepcional de apresentar risco mais alto para as DST do que as mulheres que usavam um método anticoncepcional (p=0,09). Muito poucas mulheres reportaram problemas com o uso de álcool ou de drogas ilegais, mas entre aquelas que reportaram tal uso, o risco de DST foi muito alto, particularmente para o uso de maconha. Conclusões: os achados mais significativos foram as altas taxas de doenças numa população de mulheres que reportaram de modo geral comportamentos de baixo risco de saúde. Com base nos nossos achados é essencial que se ofereça o rastreamento de DST/HIV a todas as mulheres com menos de 30 anos que visitam uma clínica de planejamento familiar. Se não se fizer esse rastreamento mais da metade das mulheres infectadas não serão identificadas ou tratadas. Considerando-se a alta sensibilidade e especificidade da nova tecnologia disponível para o rastreamento da infecção por clamídia, gonorréia e infecção por HIV, e a facilidade de se coletarem espécimes de urina para o diagnóstico, mais esforços devem ser dirigidos para a vigilância das populações de risco, para que a prática clínica corrente possa refletir o risco verdadeiro das populações servidas.

'HIV is HIV to me': The meanings of treatment, viral load and reinfection for gay men living with HIV

This paper identifies some aspects of the risk management practices of HIV positive gay men in relation to HIV treatments and sexual practice. The paper uses qualitative methods to examine sexual practice and HIV transmission in relation to HIV blood test viral load information. Questions of reinfection with HIV are also examined. Open-ended interviews were conducted with 25 gay and other homosexually active men and analysed for relevant themes. Interviewees spoke of different approaches to risk assessment in relation to viral load and reinfection, drawing on their experiences and advice. This diversity is connected with various risk management 'styles' that reflected positions about HIV transmission risk, the characteristics of the partner and the sexual situation. Some implications for HIV prevention are identified, including the need to address the links between prevention and treatment. HIV prevention strategies will need to address development of education in relation to evolving knowledge about treatment technologies and connections with HIV transmission.

Compliance with recommendations for routine HIV screening during pregnancy in Halifax

The routine offering of testing for HIV during each pregnancy is recommended by various advisory bodies, including the Canadian Paediatric Society. To determine the proportion of women in Nova Scotia who were counselled about HIV and HIV testing during their pregnancies and to determine the proportion of those who underwent the blood test after counselling. A Self-administered survey at the IWK Health Centre, Halifax, Nova Scotia was performed. Questionnaires were distributed to 800 new mothers who delivered a child between March 10 and May 10, 2000. The questionnaire asked women for their ages, levels of education, history of previous deliveries, whether they had received counselling about HIV during their pregnancy, whether they were offered an HIV blood test and whether they underwent an HIV blood test. A total of 155 questionnaires were returned (response rate of 19.4%). The proportion of women who were counselled about HIV during their pregnancy was 65 of 155 (41.9%) (95% CI 34.1 to 49.7) and the proportion of those who were counselled who underwent the test was 47 of 65 (72.3%) (95% CI 65.3 to 79.3). There was a significant difference between the proportion counselled and history of previous deliveries (P=0.050), the proportion offered a test and their ages (P=0.028), and the proportion who had a test done and their ages (P=0.017). There is inadequate compliance with the recommendation that all women be offered HIV testing during each pregnancy at the IWK Health Centre. Health care professionals involved in obstetrics need to be reminded of the importance of HIV counselling and testing during pregnancy. Further evaluation throughout Canada of the effect of HIV screening recommendations during pregnancy is advisable.

Compliance with recommendations for routine HIV screening during pregnancy in Halifax

BACKGROUND: The routine offering of testing for HIV during each pregnancy is recommended by various advisory bodies, including the Canadian Paediatric Society. OBJECTIVES: To determine the proportion of women in Nova Scotia who were counselled about HIV and HIV testing during their pregnancies and to determine the proportion of those who underwent the blood test after counselling. METHODS: A Self-administered survey at the IWK Health Centre, Halifax, Nova Scotia was performed. Questionnaires were distributed to 800 new mothers who delivered a child between March 10 and May 10, 2000. The questionnaire asked women for their ages, levels of education, history of previous deliveries, whether they had received counselling about HIV during their pregnancy, whether they were offered an HIV blood test and whether they underwent an HIV blood test. RESULTS: A total of 155 questionnaires were returned (response rate of 19.4%). The proportion of women who were counselled about HIV during their pregnancy was 65 of 155 (41.9%) (95% CI 34.1 to 49.7) and the proportion of those who were counselled who underwent the test was 47 of 65 (72.3%) (95% CI 65.3 to 79.3). There was a significant difference between the proportion counselled and history of previous deliveries (P=0.050), the proportion offered a test and their ages (P=0.028), and the proportion who had a test done and their ages (P=0.017). CONCLUSIONS: There is inadequate compliance with the recommendation that all women be offered HIV testing during each pregnancy at the IWK Health Centre. Health care professionals involved in obstetrics need to be reminded of the importance of HIV counselling and testing during pregnancy. Further evaluation throughout Canada of the effect of HIV screening recommendations during pregnancy is advisable.

Clinical, cerebrospinal fluid and pathological findings and outcomes in HIV-positive and HIV-negative patients with tuberculous meningitis.

The early diagnosis of tuberculous (TB) meningitis remains difficult. In South Africa, the HIV epidemic has shifted the spectrum of meningitis towards chronic infections (mainly tuberculosis [TB] and cryptococcosis). This study aimed to analyze clinical, cerebrospinal fluid (CSF) and pathological findings and outcomes in TB meningitis to evaluate whether HIV infection significantly influences the characteristic findings. 40 consecutive patients with TB meningitis presenting at the Pretoria Academic Hospital were evaluated clinically and chest X-rays (CXR), computerized tomography (CT) brain scans, CSF profiles, HIV and routine blood tests were analyzed. Postmortem examinations (PM) were performed in seven patients and outcomes were assessed after treatment. 20 patients were HIV-positive and 17 were negative (three not tested). History and clinical findings were similar in both groups. The mean Glasgow Coma Scale (GCS) value on admission was 13 in both groups, while CXR showed abnormalities consistent with TB in 9/17 with HIV and 7/15 without, with abnormal CT brain scans in 15/19 patients with HIV and 12/16 without. Dilated ventricles and infarcts occurred more commonly in HIV-positive patients. The CSF results showed similar results in both groups. PM in three HIV-positive patients showed weakly formed granulomas and extensive endarteritis and infarcts. Outcomes were similar in the two groups, but a low GCS value on admission was a better prognostic indicator than the CD4-count in HIV-positive patients. HIV infection does not significantly alter clinical and CSF findings in TB meningitis in South Africa, but ventricular dilatation and infarcts are more frequent in HIV-positive patients. The GCS gives a better indicator of prognosis than the CD4-count.

Risk Factors for HIV-1 Seroprevalence among Family Planning Clients in Dar es Salaam, Tanzania

Between March and September of 1995, women receiving family planning (FP) services in three large clinics in Dar es Salaam, Tanzania were invited to participate in a cross-sectional study. Consenting women were interviewed to obtain information about HIV risk factors, and blood for HIV testing was collected. The prevalence of HIV was 16.9% (95% CI: 14.4%-19.3%). The risk of HIV increased significantly with age. Compared with married women, the risk of HIV was significantly higher among cohabiting women (age-adjusted OR = 2.3; 95% CI = 1.5-3.5) and among women who were single, divorced or widowed (age-adjusted OR = 2.3; 95% CI = 1.2-4.4). The risk of HIV was also significantly higher among hotel workers (age-adjusted OR = 4.3; 95% CI = 1.4-12.9). Women with laboratory evidence of sexually transmitted diseases were at increased risk of HIV. This study shows that HIV is a major public health problem among FP clients in Tanzania. Innovative HIV interventions are needed to reduce further spread of HIV infection.

Prevalence and incidence of bloodborne viral infections among Danish prisoners.

In order to determine the prevalence and incidence of bloodborne viral infections among prisoners, we conducted a prospective study in a Danish medium security prison for males. The prisoners were offered an interview and blood test for hepatitis and human immunodeficiency virus HIV at inclusion as well as at release from prison or end of study. Of 403 prisoners available 325 (79%) participated in the initial survey and for 142 (44%) a follow-up test was available. 43% (140/325) of the participants were injecting drug users (IDUs) of whom 64% were positive for hepatitis B (HBV) and 87% for hepatitis C (HCV) markers. No cases of HIV or human T lymphotropic virus (HTLV) were found. 32% of all prisoners could transmit HBV and/or HCV by blood contact. 70% of IDUs had shared injecting equipment, and 60% had injected inside prison. Only 2% of IDUs were vaccinated against HBV. Duration of injecting drug use, numbers of imprisonments, and injecting in prison were independently and positively associated with the presence of HBV antibodies among IDUs by logistic regression analysis. The HBV incidence was 16/100 PY (95% CI: 2-56/100 PY) and the HCV incidence 25/100 PY (1-140) among injecting drug users (IDUs). We conclude that IDUs in prison have an incidence of hepatitis B and C 100 times higher than reported in the general Danish population. They should be vaccinated against hepatitis B and new initiatives to stop sharing of injecting equipment in and outside prison is urgently needed.

Injecting Drug Use Amongst Inmates in Greek Prisons

We present a national cross-sectional comparative study of injecting drug use amongst male inmates in Greek prisons in relation to demographic and penal variables. A representative sample of 1,000 inmates were randomly selected from ten correctional institutions. 861 questionnaires were included in the analysis. 290 inmates (33.6%) reported injecting drugs, of whom 174 (60%) had injected while in prison, and 146 (50.3%) had shared sometime while in prison. Inmate injectors were predominately aged 25 to 34 years; they were incarcerated mostly due to drug offences (54.7%) and offences against property (30.5%); they were characterised by a multiplicity of previous sentences and a long duration of total time in prison. Most of the injectors had been convicted for drug offences in the past. Injectors, compared to non-injectors, were more likely to have had an HIV blood test. Regarding their sexual behaviour during the twelve months prior to imprisonment, injectors were more likely to have multiple female sexua...

C-C chemokines, pivotal in protection against HIV type 1 infection.

Exposure to HIV type 1 (HIV-1) does not usually lead to infection. Although this could be because of insufficient virus titer, there is now abundant evidence that some individuals resist infection even when directly exposed to a high titer of HIV. This protection recently has been correlated with homozygous mutations of an HIV-1 coreceptor, namely CCR5, the receptor for the beta-chemokines. Moreover, earlier results already had shown that the same chemokines markedly suppress the nonsyncitial inducing variants of HIV-1, the chief virus type transmitted from person to person. CCR5 mutation, as a unique mechanism of protection, is, however, suspect because HIV-1 variants can use other chemokine receptors as their coreceptor. Moreover, recent results have established that infection can indeed sometimes occur with such mutations. Here, we report on transient natural resistance over time of most of 128 hemophiliacs who were inoculated repeatedly with HIV-1-contaminated Factor VIII concentrate from plasma during 1980-1985 before the development of the HIV blood test. Furthermore, and remarkably, 14 subjects remain uninfected to this date, and in these subjects we found homozygous CCR5 mutations in none but in most of them overproduction of beta chemokines. In vitro experiments confirmed the potent anti-HIV suppressive effect of these chemokines.