Diagnosis Of Human Immunodeficiency Virus Infection Research Articles

Evolution of an Electronic Health Record Based-Human Immunodeficiency Virus (HIV) Screening Program in an Urban Emergency Department for Diagnosing Acute and Chronic HIV Infection.

Since 2006, Centers for Disease Control and Prevention guidelines recommend routine opt-out human immunodeficiency virus (HIV) testing among sexually active 13- to 64-year-olds. Earlier diagnosis and treatment of HIV infection reduces morbidity and mortality and can limit transmission to others. Our aim was to increase HIV testing, diagnosis, and linkage to care in the emergency department (ED). Beginning May 4, 2015, we utilized our electronic health record (EHR) to enhance HIV testing in patients seen in the Rush University Medical Center emergency department in Chicago, IL, who were 13-64years of age, did not have HIV listed on their problem list, and did not have an HIV antigen/antibody (Ag/Ab) test in the EHR within the past rolling 12-month period. Strategies included use of a "Best Practice Advisory" and later auto-order screening linked to a complete blood count order. Our baseline HIV test rate was 2.5% of the target population by age (average of 93 tests per month). From May 4, 2015 to January 31, 2019, 137,749 patients of 240,091 ED visits met our test criteria and 23,588 (17.1% of the target population) HIV Ag/Ab tests were performed, resulting in 164 positive tests. We identified 18 acute seroconverters, 51 new chronically infected persons, and 95 known infected, many of who had not disclosed their status. Our positive test rate was 0.70%, which dropped to 0.29% if only newly diagnosed individuals were counted. EHR enhancements in a large urban ED identifies both newly diagnosed acute and chronically HIV-infected persons. Identification of previously diagnosed patients offers an opportunity to relink them to care.

National Latinx AIDS Awareness Day - October 15, 2019.

National Latinx AIDS Awareness Day, October 15, is observed each year to focus on the continuing and disproportionate impact of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) on Hispanics/Latinos in the United States. In 2017, 26% of newly diagnosed HIV infections occurred in Hispanics/Latinos (1). Seventy-five percent of these newly diagnosed HIV infections in Hispanics/ Latinos were in men who have sex with men (MSM), and an additional 3% were in MSM who inject drugs (1).

Prevalence and route of transmission of undiagnosed human immunodeficiency virus infection among children using provider-initiated testing and counselling strategy in Ido-Ekiti, Nigeria: a cross-sectional study.

IntroductionNinety-one percent of global Human Immunodeficiency Virus (HIV) infection in children occurs in sub-Saharan Africa. Provider Initiated Testing and Counselling (PITC) Strategy is a means of reducing missed opportunities for HIV exposed or infected children. The present study determined the prevalence of HIV infection using PITC Strategy among children seen at the Paediatric Emergency Unit of Federal Medical Centre (FMC), Ido-Ekiti, and the possible route of transmission.MethodsCross-sectional study on prevalence of HIV infection using PITC model. 530 new patients whose HIV serostatus were unknown and aged 15 years or below were recruited consecutively and offered HIV testing. Serial algorithm testing for HIV infection using Determine HIV-1/2 and Uni-Gold rapid test kits was adopted. Seropositive patients younger than eighteen months had HIV Deoxyribonucleic Acid Polymerase Chain Reaction (HIV DNA PCR) test for confirmation.ResultsTwenty-four (4.5%) of the 530 patients were confirmed to have HIV infection; of whom 19 (79.2%) were less than 18 months of old; with age range of 5 to 156 months. Fifteen (62.5%) of the infected children were females; likewise, the gender specific infection rate was higher (%) among the females compared with (%) among the males. Two of the HIV infected children’s mothers were late, while the remaining 22 mothers (%) were HIV seropositive. Mother-to-child-transmission was the most likely route of transmission in the children.ConclusionPITC strategy is vital to the early diagnosis and effective control of HIV infection in children. However, this cannot be totally effective if PMTCT is not optimized.

3039 Esophageal Ulcers: A Presenting Symptom of Acute HIV Infection

INTRODUCTION: Dysphagia and odynophagia are commonly encountered in patients who are immunocompromised from chronic Human Immunodeficiency Virus (HIV) infection. Acute HIV infection can also cause odynophagia due to abrupt onset of oropharyngeal mucosal disease. We describe the eventual diagnosis of acute HIV infection in a patient presenting with dysphagia and odynophagia following endoscopic finding of esophageal ulceration. CASE DESCRIPTION/METHODS: A 43-year-old man presented with one week of epigastric pain, dysphagia, and odynophagia in the setting of recent fever (TMax 102.8F) and chills. He had intermittently taken a PPI following an emergency room visit the previous week. Oropharyngeal exam was negative for ulcers or thrush and abdominal exam was benign. Initial labs were normal aside from mild leukopenia (WBC 3,100/uL) with a low absolute neutrophil count. He underwent EGD showing several deep distal esophageal ulcers. Pathology showed acute esophagitis with mild to severe neutrophilic infiltrate and neutrophilic microabscesses. Staining of the ulcer biopsy specimens was negative for cytomegalovirus (CMV), herpes simplex virus (HSV) and fungal elements. The unknown etiology of his esophageal ulcers prompted testing for HIV. HIV immunoassay was positive however antibody differentiation was indeterminate. A subsequent HIV viral load was positive indicating acute HIV-1 infection. He was placed on anti-retroviral therapy soon after. A repeat EGD was performed three months later, demonstrating complete resolution of the previously seen ulcers. DISCUSSION: Presenting signs and symptoms of acute symptomatic HIV infection are nonspecific and the diagnosis is often missed or delayed. Esophageal ulceration may be underrecognized as an acute manifestation of illness. In one study of 16 men presenting with odynophagia who were eventually found to have acute HIV infection (HIV serology negative at presentation), all 16 were found to have esophageal ulceration during index endoscopy. Identification of viral particles resembling HIV-1 within ulcer biopsies with electron microscopy and isolation of HIV-1 from an ulcer biopsy specimen raise the possibility of direct viral infection of esophageal cells. With this in mind, endoscopists and gastroenterology providers should have a high index of suspicion for acute HIV infection in patients with odynophagia secondary to esophageal ulcer of unknown etiology.

National Gay Men's HIV/AIDS Awareness Day - September 27, 2019.

National Gay Men's HIV/AIDS Awareness Day, September 27, directs attention to the impact of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) on gay, bisexual, and other men who have sex with men (MSM). In 2017, MSM accounted for 67% of new diagnoses of HIV infection, and MSM who inject drugs an additional 3% (1).

Injection Practices and Sexual Behaviors Among Persons with Diagnosed HIV Infection Who Inject Drugs — United States, 2015–2017

During 2016, 6% of persons in the United States who received a diagnosis of human immunodeficiency virus (HIV) infection had their HIV infection attributed to injection drug use (1). Injection practices and sexual behaviors among HIV-positive persons who inject drugs, such as injection equipment sharing and condomless sex, can increase HIV transmission risk; nationally representative estimates of the prevalences of these behaviors are lacking. The Medical Monitoring Project (MMP) is an annual, cross-sectional survey that reports nationally representative estimates of clinical and behavioral characteristics among U.S. adults with diagnosed HIV (2). CDC used MMP data to assess high-risk injection practices and sexual behaviors among HIV-positive persons who injected drugs during the preceding 12 months and compared their HIV transmission risk behaviors with those of HIV-positive persons who did not inject drugs. During 2015-2017, approximately 10% (weighted percentage estimate) of HIV-positive persons who injected drugs engaged in distributive injection equipment sharing (giving used equipment to another person for use); nonsterile syringe acquisition and unsafe disposal methods were common. Overall, among HIV-positive persons who injected drugs, 80% received no treatment, and 57% self-reported needing drug or alcohol treatment. Compared with HIV-positive persons who did not inject drugs, those who injected drugs were more likely to have a detectable viral load (48% versus 35%; p = 0.008) and engage in high-risk sexual behaviors (p<0.001). Focusing on interventions that reduce high-risk injection practices and sexual behaviors and increase rates of viral suppression might decrease HIV transmission risk among HIV-positive persons who inject drugs. Successful substance use treatment could also lower risk for transmission and overdose through reduced injection.

Experiences of patients with primary HIV diagnosis in Kermanshah-Iran regarding the nature of HIV/AIDS: A qualitative study

BackgroundA diagnosis of HIV (human immunodeficiency virus) infection causes a wide range of mental challenges regarding the meaning and understanding of such a diagnosis because of the specific nature of HIV and its social consequences. AIDS patients perceived their disease as multidimensional Stigma and rejection and even discrimination and insult in receiving health services. Therefore, a deep awareness and understanding of an individual's meaning and interpretation of a HIV-positive diagnosis and their relevant experiences are essential for providing better care. ObjectiveThis study aimed to examine the attitude, understanding, and interpretation of a positive diagnosis of HIV. MethodsThe present qualitative study was based on the descriptive phenomenological method. Participants included 13 HIV-positive patients who had been referred to the Kermanshah Counseling Center for Behavioral Diseases in Iran and diagnosed at most 6 months before being interviewed. The data were collected via semi-structured in-depth interviews. ResultsThe continuous analyses of the data and the interview notes resulted in the identification of five main themes: contagious disease with two subthemes Illness and Harm to others, new self with a Crisis of identity subtheme, disappointment with the life ending and impending death subtheme, unmentionable disease with two subthemes secretive and horrifying diseases, and loss with Frustration subtheme. ConclusionBecause the attitudes and behaviors of other people, such as relatives and people in society had a negative impact on the participants' mental status, as well as on their perceptions and understanding about the positive diagnosis, the focus of care for people with HIV/AIDS should shift from therapeutic issues to socio-cultural ones. These issues play a major role in forming an individual's understanding of HIV and can be a vital factor in improving their activities and adaptations to a positive diagnosis.

False-positive fourth-generation HIV test associated with autoimmune hemolytic anemia. Case report

Introduction: The fourth-generation ELISA human immunodeficiency virus (HIV) screening test has a high sensitivity and specificity &gt;99% to detect both antigens and antibodies. Estimates are that only 0.5% yield false positive results.Case description: 61-year-old female patient with a clinical picture consisting of malaise, unquantified fever, asthenia and adynamia. Laboratory tests revealed anemia, so a Coombs test was performed, obtaining a positive result along with other findings of mixed autoimmune hemolytic anemia. Two fourth-generation ELISA HIV screening tests were performed obtaining positive results. Given the national recommendations on the diagnosis of HIV infection, a viral load was performed, which turned out to be negative, so the result was considered a false positive.Discussion: Clinical and biological factors are related to false positive results. There are descriptions about autoimmunity phenomena, such as systemic lupus erythematosus or autoimmune hemolytic anemia, with few cases in older adults.Conclusions: Rapid tests have changed the diagnosis of HIV infection worldwide; however, like any other diagnostic test, they may yield false positive results with differential diagnoses, including autoimmune hemolytic anemia.

HIV Testing in 50 Local Jurisdictions Accounting for the Majority of New HIV Diagnoses and Seven States with Disproportionate Occurrence of HIV in Rural Areas, 2016-2017.

Since 2006, CDC has recommended universal screening for human immunodeficiency virus (HIV) infection at least once in health care settings and at least annual rescreening of persons at increased risk for infection (1,2), but data from national surveys and HIV surveillance demonstrate that these recommendations have not been fully implemented (3,4). The national Ending the HIV Epidemic initiative* is intended to reduce the number of new infections by 90% from 2020 to 2030. The initiative focuses first on 50 local jurisdictions (48 counties, the District of Columbia, and San Juan, Puerto Rico) where the majority of new diagnoses of HIV infection in 2016 and 2017 were concentrated and seven states with a disproportionate occurrence of HIV in rural areas relative to other states (i.e., states with at least 75 reported HIV diagnoses in rural areas that accounted for ≥10% of all diagnoses in the state).† This initial geographic focus will be followed by wider implementation of the initiative within the United States. An important goal of the initiative is the timely identification of all persons with HIV infection as soon as possible after infection (5). CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS)§ to assess the percentage of adults tested for HIV in the United States nationwide (38.9%), in the 50 local jurisdictions (46.9%), and in the seven states (35.5%). Testing percentages varied widely by jurisdiction but were suboptimal and generally low in jurisdictions with low rates of diagnosis of HIV infection. To achieve national goals and end the HIV epidemic in the United States, strategies must be tailored to meet local needs. Novel screening approaches might be needed to reach segments of the population that have never been tested for HIV.

Missed opportunities for earlier diagnosis of human immunodeficiency virus infection among adults presenting to Auckland District Health Board hospital services

Earlier diagnosis of human immunodeficiency virus (HIV) infection improves health outcomes and reduces transmission. In New Zealand, half of new HIV diagnoses between 2005 and 2010 had a cluster of differentiation 4 count below 350 cells/mm3 . HIV screening is already offered in antenatal settings in New Zealand, but not universally in hospital settings. To assess the impact of missed opportunities to diagnose HIV infection in adults presenting to hospital services at Auckland District Health Board (ADHB). Retrospective cohort analysis of all new diagnoses of HIV infection in adults aged 15-64 years residing within the ADHB catchment area over a 7-year period. Those who had contact with hospital services prior to diagnosis, but within their estimated window of undiagnosed infection, were compared with those without such contact. Of 201 newly diagnosed patients, 68 had prior hospital contact within their estimated window of HIV infection, 68% of whom were men who have sex with men. These patients could potentially have been diagnosed earlier by a median of 12 months (range 1-84). Missed opportunity visits occurred across a wide range of hospital services, and included visits for conditions that indicated risk for, or actual, HIV infection. Thirteen patients had HIV-associated illnesses at the time of diagnosis that could have been prevented if diagnosed earlier. Our current risk-based HIV screening strategy commonly results in late diagnosis, negative health impacts and possibly avoidable transmissions. Further study is warranted to model the feasibility and potential impact of universal HIV screening at ADHB.

An investigation of vaccination in children with human immunodeficiency virus infection

To investigate the status of vaccination in children with human immunodeficiency virus (HIV) infection. A questionnaire survey was performed in 148 children in Hunan province, China who were registered in China's Acquired Immune Deficiency Syndrome Comprehensive Response Information Management System up to December 31, 2016 and were aged <15 years at the time of confirmed diagnosis of HIV infection. The information on vaccination, diagnosis of HIV infection, and diagnosis and treatment of related diseases was collected. Of the 148 children with HIV infection, there were 70 boys (47.3%) and 78 girls (52.7%); 140 children had an age of 3.8 (0.2-14.8) years at the time of confirmed diagnosis, and 8 children refused to answer this question. Mother-to-child transmission was found in 133 children (91.7%), blood transmission in 1 child (0.7%), and unknown in 14 children (9.5%). Of the 148 children, 129 (87.2%) received antiviral therapy and 19 (12.8%) did not receive such treatment. The vaccination rates of hepatitis B vaccine, bacille Calmette-Guérin vaccine, poliomyelitis live attenuated vaccine and diphtheria-pertussis-tetanus vaccine ranged from 70.9% to 77.7%, which was significantly lower than the national level (≥97%); the vaccination rates of the other vaccines in the National Immunization Program gradually decreased with age. No severe adverse effects were reported after vaccination. Mother-to-child transmission is the main route of HIV infection in Chinese children. The diagnosis of children with HIV infection is significantly delayed, with low vaccination rates. Efforts should be made to strengthen early diagnosis, early treatment and vaccination in children with HIV infection, in order to improve their quality of life.

HIV risk and testing behaviors among pregnant women tested for HIV in Florida by site type, 2012

ABSTRACTThe numbers of perinatal human immunodeficiency virus (HIV) infections in the United States have continued to decline, but the prevalence of female adults and adolescents living with diagnosed HIV infection continues to rise. Opportunities still exist to prevent mother-to child HIV transmission. The objective of this study was to identify demographics, HIV risk, and testing behaviors among pregnant women and to compare these characteristics by HIV testing site type. Multivariable analyses were conducted to examine demographics, HIV risk, and testing behaviors among 24,836 records of pregnant women publicly tested for HIV in the state of Florida in 2012. The testing records indicated that Latina and non-Hispanic black (NHB) women had decreased odds of reporting partner risk compared to those from non-Hispanic white women (Latina: adjusted odds ratio [AOR] 0.20, 95 percent confidence interval [CI]: 0.14–0.28; and NHB AOR 0.14, 95 percent CI: 0.10–0.21), and women tested in prisons/jails had higher odds of reporting previous HIV testing compared to those tested in prenatal care sites (AOR 1.86, 95 percent CI: 1.03–3.39). An understanding of HIV risk and testing behaviors among pregnant women by site type may enhance current targeted testing and prevention strategies for pregnant women and facilitate timely linkage to care.

HIV Partner Service Delivery Among Blacks or African Americans - United States, 2016.

Identifying persons with human immunodeficiency virus (HIV) infection who are unaware of their infection status, linking them to HIV care, and reducing racial/ethnic disparities are important national HIV prevention goals (1). Blacks/African Americans (blacks)* are disproportionately affected by HIV infection in the United States. Although blacks represent 13% of the U.S. population (2), in 2017, 44% of diagnoses of HIV infection were in blacks, and the rate of new diagnoses in blacks (41.1 per 100,000 persons) was approximately eight times that of non-Hispanic whites (5.1) (3). HIV partner services are offered by health officials to persons with diagnosed HIV infection (index patients) and their sex- or needle-sharing partners, who are notified of their potential HIV exposure and offered HIV testing and related services (4). CDC analyzed 2016 data from the National HIV Prevention Program Monitoring and Evaluation system submitted by 59 health departments.† Among 49,266 index patients identified as potential candidates for partner services, 21,191 (43%) were black. The percentage of black index patients interviewed for partner services (76%) was higher than that for all index patients combined (73%). Among the 11,088 black partners named by index patients, 78% were notified of their potential HIV exposure. Fewer than half (47%) of those notified were tested for HIV infection. Among those tested, one in six (17%) received a new HIV diagnosis. The prevalence of newly diagnosed HIV infection was particularly high among black partners who were gay, bisexual, and other men who have sex with men (MSM) (37%) and transgender persons (38%). Effective implementation of partner services is important to identify HIV infection, link patients to care or reengage them in care, and provide prevention services to reduce HIV transmission.

Risk Factors for Mortality in Patients with TB/HIV Co-Infection at the General Provincial Reference Hospital of Kinshasa, Democratic Republic of the Congo

Background: The HIV (human immunodeficiency virus) pandemic has been accompanied by an increase in the incidence of many opportunistic infections like tuberculosis (TB). Despite curative and preventive efforts and free treatment for TB -HIV co-infection, the Democratic Republic of Congo remains the fourth country in Africa where the prevalence of this co-infection remains very high. The aim of this study was to identify the factors that explain mortality in patients with TB/HIV co-infection at the Kinshasa Provincial General Reference Hospital in order to reduce the incidence of complications related to this century's pandemic.Methods: The survey was conducted at the General Provincial Reference Hoisptal of Kinshasa (GPRHK), Kinshasa, DR Congo. This cross-sectional study was conducted between January and November 2018, whereby medical files for patients suffering from TB/HIV co-infection were analyzed. The sample size was determined on the basis of the Fischer formula. Thus, one hundred and forty-four (144) files were selected and consulted. Data were collected based on a pre-established, standardized and anonymous questionnaire. This questionnaire was tested on a sample of 40 files subsequently validated. Descriptive analyses were used to describe the sample profile. The correlational analysis using the Chi-square association test (X2), the confidence interval of the Odds-ratio was performed between different variables. All data were analyzed using SPSS software version 22.0. The p value < 0.05 was considered statistically significant.Results: Multiple regression analysis indicates that the main determinants of mortality in patients with TB/HIV co-infection are as follows: the main predictors of mortality from TB/HIV co-infection were, in order of importance, patients diagnosed with HIV (0.448; p0.05), patients treated with anti-tubercular drugs (0.231; p0.05). The clinical form of tuberculosis ( -0.032; p0.05) and the age of people living with HIV (0.038; p0.05) are not significantly associated with TB-HIV co-infection.Conclusion: The diagnosis of HIV infection in TB patients in the absence of anti-tuberculin prophylaxis, followed by the clinical form of tuberculosis coupled with poor compliance and significant immunosuppression are the major risk factors for mortality.

HIV infection, secondary conditions and comorbidities. Part 1: Epidemiology and the basis of the problem

An analysis of the human immunodeficiency virus (HIV) epidemic’s trajectory with priority-setting taking into account HIV-associated comorbidities for each time period was performed. A classification of comorbid diseases and conditions in HIV infection by cause and setting of their occurrence is presented. Opportunistic infections and secondary diseases that remain some of the leading causes of severe complications and mortality are characterized. The difficulty of the development of immune reconstitution inflammatory syndrome against the background of late diagnosis of HIV infection and initiation of antiretroviral therapy is highlighted.

Differences in Characteristics and Clinical Outcomes Among Hispanic/Latino Men and Women Receiving HIV Medical Care - United States, 2013-2014.

The prevalence of diagnosed human immunodeficiency virus (HIV) infection among Hispanics/Latinos in the United States is approximately twice that of non-Hispanic whites (1). Barriers to, and experiences with, medical care have been found to vary by sex (2). Describing characteristics of Hispanics/Latinos in care by sex can help identify disparities and inform delivery of tailored services to this underserved population. Data from the 2013 and 2014 cycles of the Medical Monitoring Project (MMP) were analyzed to describe demographic, behavioral, and clinical characteristics among Hispanics/Latinos by sex. MMP is an annual cross-sectional, nationally representative surveillance system that, during 2013-2014, collected information about behaviors, medical care, and clinical outcomes among adults receiving outpatient HIV care. Hispanic/Latina women were significantly more likely than were men to live in poverty (78% versus 54%), report not speaking English well (38% versus 21%), and receive interpreter (27% versus 16%), transportation (35% versus 21%), and meal (44% versus 26%) services. There were no significant differences between Hispanic/Latino women and men in prescription of antiretroviral therapy (ART) (95% versus 96%) or sustained viral suppression (68% versus 73%). Although women faced greater socioeconomic and language-related challenges, the clinical outcomes among Hispanic/Latina women were similar to those among men, perhaps reflecting their higher use of ancillary services. Levels of viral suppression for Hispanics/Latinos are lower than those found among non-Hispanic whites (3) and lower than the national prevention goal of at least 80% of persons with diagnosed HIV infection. Providers should be cognizant of the challenges faced by Hispanics/Latinos with HIV infection in care and provide referrals to needed ancillary services.

Missed Opportunities for HIV Screening Among a Cohort of Adolescents With Recently Diagnosed HIV Infection in a Large Pediatric Hospital Care Network

PurposeRoutine human immunodeficiency virus (HIV) screening reduces HIV progression and transmission. Our aims were to determine prevalence and factors associated with prior HIV screening among a cohort of youth living with HIV. MethodsRetrospective chart review of youth living with HIV aged 14–26 at an HIV clinic comparing characteristics between those with and without HIV screening within the year prior to diagnosis ResultsSubjects (n = 301) were male (85%), African-American (87%), and men who have sex with men (84%). Subjects seen 1 year prior to diagnosis (n = 58) contributed 179 visits for missed opportunities with 59% having a documented sexual history in the electronic health record and 48% tested for HIV. Subjects with symptoms suggesting acute HIV infection (51%) were more likely to be tested (p = .04). In the adjusted model, documentation of sexual history and demographic factors was not associated with prior testing. ConclusionWe identified high rates of missed opportunities for HIV testing and sexual history documentation in the year prior to diagnosis, underscoring the need for routine HIV screening in adolescents.

Age-Associated Trends in Diagnosis and Prevalence of Infection with HIV Among Men Who Have Sex with Men - United States, 2008-2016.

In 2016, two thirds of diagnosed human immunodeficiency virus (HIV) infections in the United States were attributed to male-to-male sexual contact (1). The risk for sexual acquisition and transmission of HIV changes through the lifespan (2); to better guide prevention efforts for gay, bisexual, and other men who have sex with men (MSM*), CDC analyzed National HIV Surveillance System† (NHSS) data for MSM aged ≥13 years by age group (13-29, 30-49, and ≥50 years) in 50 states and the District of Columbia (DC). During 2008-2016, the annual number of diagnoses of HIV infection increased 3% per year among MSM aged 13-29 years, decreased 4% per year among those aged 30-49 years and was stable for MSM aged ≥50 years. The number of HIV diagnoses among MSM aged 13-29 years was four times that of MSM aged ≥50 years. During 2008-2015, the number of MSM aged ≥50 years living with diagnosed HIV infection (prevalence of HIV infection) increased an average of 11% per year and at year-end 2015 was three times that of MSM aged 13-29 years. Racial/ethnic disparities in HIV infection persisted, particularly among younger black/African American MSM who accounted for 49% of all diagnoses among MSM aged 13-29 years during 2008-2016. To avert the most infections and improve health outcomes (3), sexually active MSM at risk for HIV infection should be tested at least once a year, and, if positive, linked to and retained in HIV medical care to achieve viral suppression (4). Those testing negative should be provided HIV prevention services, including preexposure prophylaxis (PrEP) (5).

THE CLINICAL MANIFESTATION OF HIV INFECTION SIMULATING RHEUMATIC DISEASES

The symptoms similar to those detected in rheumatic diseases in patients infected with human immunodeficiency virus (HIV) are due to various pathogenetic mechanisms (immune cell imbalance, antibody production, etc.). The occurrence of rheumatic symptoms and syndromes in HIV infection can lead to diagnostic errors and wrong treatment policy (use of immunosuppressive therapy instead of high-dose antiretroviral therapy). The paper describes two clinical cases of HIV infection in the stage of acquired immunodeficiency syndrome (AIDS) in young and middle-aged women, who were misdiagnosed rheumatic diseases at baseline. In the first case, a 34-year-old woman was suspected to have systemic lupus erythematosus before HIV infection diagnosis, whereas the leading clinical syndrome was nephropathy (nephrotic syndrome, hypertension). In the other case, in a 62-year-old woman, the manifestations of the advanced stage of HIV infection at baseline were regarded as mixed connective tissue disease, while the greatest similarity was found in the concurrence of Sjö gren’s syndrome. The paper discusses the reasons for diagnostic difficulties in each case and the specific features of organ damages in comparison with the data available in the literature.

ACOG Committee Opinion No. 752: Prenatal and Perinatal Human Immunodeficiency Virus Testing.

Given the enormous advances in the prevention of perinatal transmission of human immunodeficiency virus (HIV), it is clear that early identification and treatment of all pregnant women with HIV is the best way to prevent neonatal infection and also improve women's health. Furthermore, new evidence suggests that early initiation of antiretroviral therapy in the course of infection is beneficial for individuals infected with HIV and reduces the rate of sexual transmission to partners who are not infected. Screening should be performed after women have been notified that HIV screening is recommended for all pregnant patients and that they will receive an HIV test as part of the routine panel of prenatal tests unless they decline (opt-out screening). Human immunodeficiency virus testing using the opt-out approach, which is currently permitted in every jurisdiction in the United States, should be a routine component of care for women during prepregnancy and as early in pregnancy as possible. Repeat HIV testing in the third trimester, preferably before 36 weeks of gestation, is recommended for pregnant women with initial negative HIV antibody tests who are known to be at high risk of acquiring HIV infection; who are receiving care in facilities that have an HIV incidence in pregnant women of at least 1 per 1,000 per year; who are incarcerated; who reside in jurisdictions with elevated HIV incidence; or who have signs and symptoms consistent with acute HIV infection (eg, fever, lymphadenopathy, skin rash, myalgias, arthralgias, headache, oral ulcers, leukopenia, thrombocytopenia, or transaminase elevation). Rapid screening during labor and delivery or during the immediate postpartum period using the opt-out approach should be done for women who were not tested earlier in pregnancy or whose HIV status is otherwise unknown. Results should be available 24 hours a day and within 1 hour. If a rapid HIV test result in labor is reactive, antiretroviral prophylaxis should be immediately initiated while waiting for supplemental test results. If the diagnosis of HIV infection is established, the woman should be linked into ongoing care with a specialist in HIV care for comanagement.