Epidemiology Of HIV Infection Research Articles

The epidemiology of HIV infection among female sex workers in Nairobi, Kenya: A structural determinants and life-course perspective.

High HIV prevalence among female sex workers (FSWs) is heavily influenced by structural determinants (e.g. criminalisation of sex work; violence) and significant life events (e.g. orphanhood, teenage pregnancy). This study aims to understand the epidemiology of HIV among FSWs in Nairobi, Kenya using a structural determinants and life-course perspective. Baseline cross-sectional survey data were collected June-December 2019 for the Maisha Fiti study with 1003 FSWs (aged 18-45 years). Odds ratios and 95% confidence intervals were estimated using multivariable logistic regression with a hierarchical modelling approach. HIV prevalence was 28.0%, and increased with age (<25 years 5.7%, 25-34 years 19.0%, ≥35 years 40.6%). In adjusted analyses, HIV seroprevalence was associated with childhood and adolescence including violence from militia or soldiers (AOR = 1.60; 95%CI:1.00-2.53), young age at sexual debut (≤15 years old vs. ≥18 years AOR = 0.57; 95%CI:0.39-0.84) and teenage pregnancy (AOR = 1.37; 95%CI:1.00-1.88). For adulthood the factors included lower SES score (lowest vs. highest tertile AOR = 0.63; 95%CI:0.40-0.98); reduced housing insecurity (AOR = 0.52; 95%CI:0.54-0.79); lower alcohol/drug use score (AOR = 0.44; 95%CI:0.31-0.61); and a longer duration of selling sex (0-5 years vs. ≥11 years AOR = 2.35; 95%CI:1.44-3.82). Among HIV-negative FSWs, prevalence of HIV risk factors was high (recent hunger 32.3%; internalised 67.7% and experienced 66.0% sex work stigma; recent police arrest 30.1%; recent physical or sexual violence 65.6%, condomless last sex intimate partner 71.1%; harmful alcohol or substance use 49.1%). Only 24.6% of HIV-negative FSWs reported taking PrEP. Taken together, adverse events in childhood and adolescence were associated with increased odds of living with HIV, and were more strongly associated with HIV serostatus than adulthood structural or behavioural risk factors. HIV-negative FSWs remain at high risk of HIV acquisition. This study highlights the importance of addressing adverse events throughout the life course to reduce HIV risk, and the need to continue multi-level HIV prevention and treatment efforts.

Socio-Demographic Profile and Adherence to Anti-Retroviral Treatment among HIV/AIDS Patients Attending the ART Centre in Tamil Nadu

Background: Epidemiology of HIV infection in India is varied and depends on multitude of factors such as socio-demographic profile, geographic location and behavioural pattern. HIV/AIDS is not only a public health issue in India but also one of the most serious socioeconomic and developmental concerns as nearly 86% of reported cases occur in sexually active and economically productive age group (15-49yrs). Thus, for planning targeted interventions, it is essential to know the socio-demographic and clinical profile of the HIV/AIDS patients in a particular area as important for control of HIV replication, disease progression and ultimately containment of the disease. Hence this study was planned to describe the Socio-demographic profile and ART treatment adherence of People Living with HIV/AIDS attending The ART Centre, KKGMCH, Asaripallam, Kanyakumari District, Tamil Nadu. Objectives: To describe the Socio-demographic profile and ART treatment adherence of People Living with HIV/AIDS attending The ART Centre, KKGMCH, Asaripallam, Kanyakumari District, Tamil Nadu. Materials &amp; Methods: This was a Cross- sectional study conducted among adult people living with HIV/AIDS who were on treatment at ART centre. The study was done during January 2014 to July 2014. The data was collected by using a semi structured questionnaire derived from WHO-BREFQOL. Result: The age of the study population varies from minimum 18 to maximum 59 years with the mean ± SD age of 39.5 ± 8.3 years. Around 69 (46.0%) participants are in the 31 – 40 years age group followed by 51 (39.0%) are in the 41 – 50 years age group. Regarding the Family type, 127 (84.7%) are from nuclear family; 19 (12.7%) are from extended family and another 4 (2.7%) are from the Joint family. The prevalence of opportunistic symptoms among the study participants, around 44% of the study participants developed respiratory related symptoms followed by Skin (24%). Among 150 subjects taking ART, 120 (80.0%) are receiving Regimen 1 and 30 others (20%) are receiving Regimen 2. Around 92 (61.3%) have good adherence to ART. 53 (35.3%) have fair and 5 (3.3%) have poor adherence. Conclusion: Non-adherence as a hindering factor for the success of therapy is well-established. Keywords: HIV/AIDS, Socio-demographic profile, Drug Adherence, Targeted intervention

HIV among people who inject drugs in India: a systematic review

BackgroundLittle is known about the epidemiology of HIV infection among HIV positive people who inject drugs (PWID) in India. Injecting drug use has emerged as an important route of HIV transmission in India. The objective of this study was to conduct a systematic review on the risk behaviours associated with HIV infection among HIV positive PWID and assess the data reported.MethodsA systematic search of six electronic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase and Ovid Medline was conducted. These databases were searched for published studies on injecting risk behaviours, sexual risk behaviours and socio-demographic factors associated with HIV infection among HIV positive PWID in India.ResultsA total of 15 studies were included in the review of which 3 studies evaluated HIV/HCV coinfection among HIV positive PWID. Older age, low educational level and employment status were significantly associated with HIV infection. Sharing of syringe and needle, frequency of injection, early initiation of injecting practice, inconsistent condom use and having multiple sexual partners were all commonly associated with HIV infection among HIV positive PWID.ConclusionOur study identified significant injecting and sexual risk behaviours among HIV positive PWID in India. There is an increasing HIV transmission among PWID in different states, more so in the northeastern states and in metropolitan cities in India. More studies need to be conducted in other regions of the country to understand the true burden of the disease. The lack of sufficient data among HIV positive female PWID does not preclude the possibility of a hidden epidemic among female PWID. The need of the hour is for the prevention of further transmission by this high-risk group through the provision of comprehensive programs, surveillance and robust continuation of harm reduction services.

Transmission Clusters, Predominantly Associated With Men Who Have Sex With Men, Play a Main Role in the Propagation of HIV-1 in Northern Spain (2013-2018).

Viruses of HIV-1-infected individuals whose transmission is related group phylogenetically in transmission clusters (TCs). The study of the phylogenetic relations of these viruses and the factors associated with these individuals is essential to analyze the HIV-1 epidemic. In this study, we examine the role of TCs in the epidemiology of HIV-1 infection in Galicia and the Basque County, two regions of northern Spain. A total of 1,158 HIV-1-infected patients from both regions with new diagnoses (NDs) in 2013–2018 were included in the study. Partial HIV-1 pol sequences were analyzed phylogenetically by approximately maximum-likelihood with FastTree 2. In this analysis, 10,687 additional sequences from samples from HIV-1-infected individuals collected in Spain in 1999–2019 were also included to assign TC membership and to determine TCs’ sizes. TCs were defined as those which included viruses from ≥4 individuals, at least 50% of them Spaniards, and with ≥0.95 Shimodaira-Hasegawa-like node support in the phylogenetic tree. Factors associated to TCs were evaluated using odds ratios (OR) and their 95% CI. Fifty-one percent of NDs grouped in 162 TCs. Male patients (OR: 2.6; 95% CI: 1.5–4.7) and men having sex with men (MSM; OR: 2.1; 95% CI: 1.4–3.2) had higher odds of belonging to a TC compared to female and heterosexual patients, respectively. Individuals from Latin America (OR: 0.3; 95% CI: 0.2–0.4), North Africa (OR: 0.4; 95% CI: 0.2–1.0), and especially Sub-Saharan Africa (OR: 0.02; 95% CI: 0.003–0.2) were inversely associated to belonging to TCs compared to native Spaniards. Our results show that TCs are important components of the HIV-1 epidemics in the two Spanish regions studied, where transmission between MSM is predominant. The majority of migrants were infected with viruses not belonging to TCs that expand in Spain. Molecular epidemiology is essential to identify local peculiarities of HIV-1 propagation. The early detection of TCs and prevention of their expansion, implementing effective control measures, could reduce HIV-1 infections.

Epidemiology of HIV infection and associated behaviours among people who inject drugs in England, Wales, and Northern Ireland: Nearly 40years on.

IntroductionPeople who inject drugs are at high risk of blood‐borne infections. We describe the epidemiology of HIV among people who inject drugs in England, Wales, and Northern Ireland (EW&NI) since 1981.MethodsNational HIV surveillance data were used to describe trends in diagnoses (1981–2019), prevalence (1990–2019), and behaviours (1990–2019) among people who inject drugs aged ≥15 years in EW&NI. HIV care and treatment uptake were assessed among those attending in 2019.ResultsOver the past four decades, the prevalence of HIV among people who inject drugs in EW&NI remained low (range: 0.64%–1.81%). Overall, 4978 people who inject drugs were diagnosed with HIV (3.2% of cases). Diagnoses peaked at 234 in 1987, decreasing to 78 in 2019; the majority were among white men born in the UK/Europe (90%), though the epidemic diversified over time. Late diagnosis (CD4 <350 cells/µl) was common (2010–2019: 52% [429/832]). Of those who last attended for HIV care in 2019, 97% (1503/1550) were receiving HIV treatment and 90% (1375/1520) had a suppressed viral load (<200 copies/ml).HIV testing uptake has steadily increased among people who inject drugs (32% since 1990). However, in 2019, 18% (246/1404) of those currently injecting reported never testing. The proportion of people currently injecting reporting sharing needles/syringes decreased from 1999 to 2012, before increasing to 20% (288/1426) in 2019, with sharing of any injecting equipment at 37% (523/1429).ConclusionThe HIV epidemic among people who inject drugs in EW&NI has remained relatively contained compared with in other countries, most likely because of the prompt implementation of an effective national harm reduction programme. However, risk behaviours and varied access to preventive interventions among people who inject drugs indicate the potential for HIV outbreaks.

A scoping review of HIV epidemiologic, sociocultural and programmatic studies related to transgender women and men who have sex with men in Cambodia, 1999-2019.

BackgroundCambodia is widely credited for its successful HIV epidemic control. However, in recent years there have been signs of increasing HIV prevalence among men who have sex with men (MSM) and transgender women (TGW). This paper reviews HIV epidemiological, social science and HIV program implementation studies conducted over the past 20 years to explore possible reasons for the rising HIV prevalence among these groups and to formulate recommendations for improved policies, HIV programmatic interventions and further research.MethodsFor this scoping review, we searched the PubMed and Google Scholar databases for scientific publications related to HIV and MSM and TGW in Cambodia published since 1999. From each of the returned citations we subsequently studied reference lists to find additional data sources. We also searched websites for reports commissioned by national and international governmental and non-governmental organizations.ResultsTwenty-seven relevant studies and papers were found and reviewed; most were epidemiological in nature. Recent epidemiological studies and reports show an increase in HIV prevalence among Cambodian MSM and TGW. The epidemiology of HIV infection in these groups has been relatively well-described and analyzed. While initially MSM and TGW were grouped together, in more recent years they have been studied in their own right, recognizing their specific HIV and other prevention needs. Few studies were found investigating Cambodian same-sex cultures and social and cultural contexts in which HIV transmission among MSM and TGW occurs. A few evaluation studies were found, but it remains unknown how effective current HIV service implementation modalities are, or how successful strategies to increase access to essential HIV prevention, testing and treatment services have been employed for MSM and TGW in Cambodia.ConclusionsResearch about Cambodian MSM and TGW in the context of HIV primarily concerns bio-behavioral knowledge generation. Cambodia is unlikely to achieve control of the HIV epidemic among MSM and TGW without doing better in-depth social science research on its multiple sexual- and gender minority cultures, and without understanding what differentiated implementation modalities, strategies and approaches are most effective to address HIV among its increasingly diverse MSM and TGW populations.

The Epidemiology of HIV/AIDS in Anguilla from 1988 to 2011

This study was carried out on the Caribbean Island of Anguilla for the purpose of analyzing surveillance data related to the epidemiology of HIV infection in Anguilla from 1988 to 2011. We retrieved data from the National AIDS Programme office for research purpose. Data on HIV/AIDS in Anguilla were retrieved from 1988 to 2011 and analyzed with particular emphasis on the year 2011. The retrieved data provided key information on new cases, deaths, and treatment of existing cases. Result analysis shows that by December 31, 2011, the cumulative number of all HIV cases diagnosed since the surveillance started in 1988 was 42. Males accounted for 23 (54.8%), while females accounted for 19 (45.2%) of the diagnosed cases. There were 17 cases comprising 12 males (70.5%) and 5 females (29.5%), HIV-related deaths within the same period. No cases of AIDS were reported in the study period. The year with the highest number of HIV diagnosis was 1996, with 7 confirmed new cases. HIV prevalence in Anguilla is estimated to be 0.19%. The number of tests conducted in 2008 holds steadfast as the highest in the 4 consecutive years from 2008 to 2011. There were 9 clients that received treatment and care from the Clinical Care Coordinator within the period under review. Data provided in this study shows a gradual decline in the incidence of HIV infection in Anguilla since it was first diagnosed in 1988. This is attributable to public awareness, surveillance, and access to antiretroviral treatment (ARVT).

2519. Urban vs Rural HIV-infected Persons Have Differential Gene Expression for Estrogen Signaling, Inflammation, and Cytokine Production Pathways

BackgroundPeople aging with HIV (PAWH) are living longer with effective antiretroviral therapy and new HIV diagnoses are rising in older populations. Concurrent with trends in age, the epidemiology of HIV infection in the United States has shifted geographically and racially; the Southeast and African Americans now have the highest HIV incidence and prevalence. Although there are marked health disparities for rural and African American PAWH, limited data exist comparing aging phenotypes between rural and urban PAWH, and no data exist comparing mechanistic pathways between these populations. Among African American PAWH, we hypothesize that rural PAWH will be more likely than urban PAWH to have a molecular profile of advanced aging associated with chronic disease burden and shorter health span.MethodsDemographics, clinical data, and RNA were collected from 14 matched pairs from rural (Wake Forest University, Winston-Salem, NC) and urban cohorts (ALiVE cohort, Johns Hopkins University, Baltimore, MD) matched on age, sex, Short Physical Performance Battery score, smoking status, and sample collection date. Raw sequences were examined for quality, aligned using STAR, and normalized using DESeq2. DESeq2 tested matched pair differential gene expression. Genes with an average read count threshold > 5, a genomic control adjusted P-value < 0.01 and a fold change > 1.3 were retained for further analysis using STRING, MCODE, and IPA to find functional and biological patterns.ResultsOf the 399 genes meeting significance criteria, 212 showed higher expression in the rural group; the remaining 187 genes showed lower expression in the rural group. Top enriched canonical pathways in the IPA analysis identified differential estrogen signaling (P < 0.0001), inflammation (P < 0.001), and cytokine production (p = 0.005). Protein–protein interactions involved in cell–cell signaling and intracellular trafficking were also differentially identified between the 2 populations.ConclusionUrban and rural PAWH have differential gene expression, particularly centered around estrogen signaling and inflammatory cytokine production. These findings merit further investigation to determine clinical significance, including correlation with phenotypes and healthspan between rural and urban PAWH.Disclosures All authors: No reported disclosures.

Epidemiology of HIV Infection and Molecular and Genetic Features of the Virus at the Infected Persons in Siberian Federal District

Relevance. HIV infection epidemic in the Siberian Federal District (SFD) continues to develop with a tendency to incidence growth. The prevalence indicator in the district on 1/1/2015 made 948,4 on 100 thousand of the population. Since 1996 within 20 years in Siberian federal district the group which is the most affected with HIV infection were the consumers of injecting drugs (CID). The greatest number of patients with HIV is registered among males from risk groups in age group of 30 - 39 years (25.8%). And the combined infections lead risky behavior in respect of HIV infection to increase in number of the dead. Goal. Studied the frequency distribution of mutations associated with resistance of human immunodeficiency virus to three main classes of antiretrovirals in patients on therapy, as well as «naive» patients Materials and methods. The study is supposed to monitor the epidemic process of HIV infection in the Siberian Federal District in 2001 - 2015. Results. Patients on therapy, noted the prevalence of mutations of HIV to nucleoside and nonnucleoside reverse transcriptase inhibitors. The "naive" patients in the majority of cases revealed no mutations associated with resistance. Conclusions. Established the dominance of HIV subtype A1, along with a significant proportion of circulating recombinant form 02_AG and 63_02А1.

Prevalence of Hepatitis B, C and HIV infection in blood donors of Multan region

Acute and chronic viral hepatitis are common public health problems in Pakistan, and associated with serious complications. The carrier rate of HBsAg is quoted to be around 10% in general population while the prevalence of HCV in blood donors is 4.8 %. Data regarding the prevalence of hepatitis B and C virus infections among healthy blood donors is well established in Karachi, Rawalpindi, Islamabad, Faisalabad, Lahore and Abbotabad areas, but similar data is not available for Multan population. Data regarding the epidemiology of HIV infection among blood donors is not available at most of the blood transfusion centers. In this study six thousands (6000) consecutive young healthy voluntary blood donors (age 16-50 years) comprising of 5476 males and 524 females, belonging to Multan region were included from "Blood Transfusion Center Nishtar Hospital Multan" &amp; "Fatmid Blood Transfusion Center Multan" and were tested for HbsAg, Anti-HCV and HIV. Prevalence of Hepatitis B, C and HIV Infection was 3.37%, 0.27% and 0% respectively. The reported prevalence figures for HBsAg &amp; Anti-HCV in other studies are quite variable, depending upon screening protocol, study groups selected and methodology of testing. If data from all the blood transfusion centers of Pakistan is collected and published, we can get representative prevalence values of HBV, HCV and HIV infection of the general population.

HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities.

Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Sub-Saharan Africa carries a disproportionate burden of HIV, accounting for more than 70% of the global burden of infection. Success in HIV prevention in sub-Saharan Africa has the potential to impact on the global burden of HIV. Notwithstanding substantial progress in scaling up antiretroviral therapy (ART), sub-Saharan Africa accounted for 74% of the 1.5 million AIDS related deaths in 2013.Of the estimated 6000 new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden. Adolescent girls and young women aged 15-24 years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships.The possibility of an AIDS free generation cannot be realized unless we are able to prevent HIV infection in young women. This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.

Epidemiology of HIV-Associated Lung Disease in the United States.

The epidemiology of HIV infection and its pulmonary complications in the United States has evolved significantly over nearly 20 years since the advent of combination antiretroviral therapy. While infectious complications are less of a threat to patients whose immune systems have been restored, many HIV-infected persons in the United States remain at high risk for opportunistic infection because they are unaware of their HIV infection, have difficulty maintaining linkage to care, or maintain inadequate viral control. Bacterial pneumonia and Pneumocystis pneumonia remain significantly more prevalent among HIV-infected persons, and together with seasonal influenza are areas where public health efforts to increase antiretroviral therapy, appropriate prophylaxis, and vaccination may decrease burden of disease. Noninfectious pulmonary complications of chronic HIV infection are increasingly recognized in the United States and elsewhere. Chronic obstructive pulmonary disease, asthma, pulmonary hypertension, sleep-disordered breathing, and primary lung cancer may all be more common among persons with HIV; of concern, disease burden in U.S. HIV-infected persons may be underestimated due to lack of diagnostic testing for these conditions. Smoking is among the most prevalent preventable causes of morbidity and mortality affecting persons living with HIV infection, and has particular import to pulmonary disease. As of 2009, 42% of HIV-infected adults in medical care in the United States smoked tobacco (over twice the national rate in the general population). Successful efforts to promote smoking cessation among HIV-infected persons are of critical importance to decrease the burden of chronic pulmonary disease.

Prevalence of HIV Among U.S. Female Sex Workers: Systematic Review and Meta-analysis.

Although female sex workers are known to be vulnerable to HIV infection, little is known about the epidemiology of HIV infection among this high-risk population in the United States. We systematically identified and critically assessed published studies reporting HIV prevalence among female sex workers in the United States. We searched for and included original English-language articles reporting data on the prevalence of HIV as determined by testing at least 50 females who exchanged sexual practices for money or drugs. We did not apply any restrictions on date of publication. We included 14 studies from 1987 to 2013 that reported HIV prevalence for a total of 3975 adult female sex workers. Only two of the 14 studies were conducted in the last 10years. The pooled estimate of HIV prevalence was 17.3% (95% CI 13.5-21.9%); however, the prevalence of HIV across individual studies varied considerably (ranging from 0.3 to 32%) and statistical heterogeneity was substantial (I(2)=0.89, Q=123; p<0.001). Although the variance across the 14 studies was high, prevalence was generally high (10% or greater in 11 of the 14 included studies). Very few studies have documented the prevalence of HIV among female sex workers in the United States; however, the available evidence does suggest that HIV prevalence among this vulnerable population is high.

Strategies for the prevention of mother to child transmission in Western countries: an update.

During the last decades remarkable scientific advances have been made toward the prevention of HIV mother-to-child transmission, in particular in developed nations. The aim of this review was to analyze the latest findings and available international recommendations on the prevention of HIV mother-to-child transmission in high-income countries. We performed a literature search of the Cochrane Library, MEDLINE by PubMed and EMBASE from database inception through June 2014, using the following terms: HIV, mother-to-child transmission and mother-to-child-transmission prevention. All types of articles in the English language were included. US and available European guidelines were searched and included in the analysis. One hundred fifty articles were selected for inclusion in this review. Global epidemiology of HIV infection is rapidly evolving, in particular in high-resource countries. The interpretation of clinical and epidemiological studies is crucial for the development of evidence-based recommendations to guide the management of HIV mother-to-child transmission. Although significant progress has been made, heterogeneity between countries in specific interventions still exists, which may address future research.

HIV among people who inject drugs in the Middle East and North Africa: systematic review and data synthesis.

It is perceived that little is known about the epidemiology of HIV infection among people who inject drugs (PWID) in the Middle East and North Africa (MENA). The primary objective of this study was to assess the status of the HIV epidemic among PWID in MENA by describing HIV prevalence and incidence. Secondary objectives were to describe the risk behavior environment and the HIV epidemic potential among PWID, and to estimate the prevalence of injecting drug use in MENA. This was a systematic review following the PRISMA guidelines and covering 23 MENA countries. PubMed, Embase, regional and international databases, as well as country-level reports were searched up to December 16, 2013. Primary studies reporting (1) the prevalence/incidence of HIV, other sexually transmitted infections, or hepatitis C virus (HCV) among PWIDs; or (2) the prevalence of injecting or sexual risk behaviors, or HIV knowledge among PWID; or (3) the number/proportion of PWID in MENA countries, were eligible for inclusion. The quality, quantity, and geographic coverage of the data were assessed at country level. Risk of bias in predefined quality domains was described to assess the quality of available HIV prevalence measures. After multiple level screening, 192 eligible reports were included in the review. There were 197 HIV prevalence measures on a total of 58,241 PWID extracted from reports, and an additional 226 HIV prevalence measures extracted from the databases. We estimated that there are 626,000 PWID in MENA (range: 335,000-1,635,000, prevalence of 0.24 per 100 adults). We found evidence of HIV epidemics among PWID in at least one-third of MENA countries, most of which are emerging concentrated epidemics and with HIV prevalence overall in the range of 10%-15%. Some of the epidemics have however already reached considerable levels including some of the highest HIV prevalence among PWID globally (87.1% in Tripoli, Libya). The relatively high prevalence of sharing needles/syringes (18%-28% in the last injection), the low levels of condom use (20%-54% ever condom use), the high levels of having sex with sex workers and of men having sex with men (15%-30% and 2%-10% in the last year, respectively), and of selling sex (5%-29% in the last year), indicate a high injecting and sexual risk environment. The prevalence of HCV (31%-64%) and of sexually transmitted infections suggest high levels of risk behavior indicative of the potential for more and larger HIV epidemics. Our study identified a large volume of HIV-related biological and behavioral data among PWID in the MENA region. The coverage and quality of the data varied between countries. There is robust evidence for HIV epidemics among PWID in multiple countries, most of which have emerged within the last decade and continue to grow. The lack of sufficient evidence in some MENA countries does not preclude the possibility of hidden epidemics among PWID in these settings. With the HIV epidemic among PWID in overall a relatively early phase, there is a window of opportunity for prevention that should not be missed through the provision of comprehensive programs, including scale-up of harm reduction services and expansion of surveillance systems.

A short review on the relation between the dopamine transporter 10/10-repeat allele and ADHD: implications for HIV infection

The dopamine transporter (DAT) is a functional element of the dopaminergic synapse in the brain. Its primary role is the regulation of dopamine (DA) availability by forward and reverse transport of DA from and to the synaptic cleft by which extracellular DA concentrations are being regulated. The DAT gene and especially the DAT 10/10 genotype have been intensively discussed as a candidate for several neuropsychiatric disorders including attention-deficit-hyperactivity disorder (ADHD). We found recently that the DAT 10/10 genotype is associated with increased levels of CSF DA and is present more frequently in HIV-infected individuals than in uninfected subjects, suggesting that personality traits related to this polymorphism may increase the risk of acquisition of HIV. In this article, we review studies on the DAT 10/10 genotype and the association with ADHD and its endophenotypes, express concerns on the reported DA neurochemistry in ADHD and discuss consequences of the DAT 10/10 genotype on the epidemiology of HIV infection.

The epidemiology of HIV infection in Morocco: systematic review and data synthesis

SummaryMorocco has made significant strides in building its HIV research capacity. Based on a wealth of empirical data, the objective of this study was to conduct a comprehensive and systematic literature review and analytical synthesis of HIV epidemiological evidence in this country. Data were retrieved using three major sources of literature and data. HIV transmission dynamics were found to be focused in high-risk populations, with female sex workers (FSWs) and clients contributing the largest share of new HIV infections. There is a pattern of emerging epidemics among some high-risk populations, and some epidemics, particularly among FSWs, appear to be established and stable. The scale of the local HIV epidemics and populations affected show highly heterogeneous geographical distribution. To optimize the national HIV response, surveillance and prevention efforts need to be expanded among high-risk populations and in geographic settings where low intensity and possibly concentrated HIV epidemics are emerging or are already endemic.

P3.190 Epidemiology of HIV Infection Before and After Rising the Iron Curtain: The Hungarian Experience

BackgroundIn the beginning of 21st Century Hungary has a good epidemiological situation concerning HIV infections and AIDS which was the result of the strict but consistent introduction of nationwide HIV...

The changing epidemiology of HIV in 2013

We sought to review the recent epidemiology of HIV-1 and to identify emerging challenges in HIV surveillance and epidemic control. There is increasing evidence that HIV epidemics are in decline among general populations worldwide. Critical exceptions to these trends are HIV epidemics among key populations globally; the HIV epidemics in Eastern Europe and Central Asia in injecting drug using populations; the continued high burden epidemics of sexually transmitted HIV among young women and girls in southern sub-Saharan Africa, and young men who have sex in men (MSM) in the America, Asia, and Africa. In the new era of ART access, prevalence measures over time are less reliable and new approaches to the measurement of incident infection will be critical to assess trends. The implementation of expanded options for HIV prevention, reducing vertical transmission, and treatment as prevention, will shift focus from individuals to population-level impact. Strong surveillance and information systems will be necessary to meet these expanded surveillance needs. The epidemiology of HIV infection is changing, dynamic, complex, and progress in epidemic control remains markedly uneven. Without addressing the components of global HIV, in which disease rates continue to expand, current efforts are unlikely to succeed.

Epidemiology of HIV Infection in Central Brazil: Data From Voluntary Counseling and Testing Centers

Voluntary counseling and testing (VCT) is recommended to facilitate early identification of HIV infection. Data from VCT centers in Goiás and Federal District, Central Brazil, evaluated HIV prevalence and identified risk factors for HIV among individuals ages 13 years and older. Results indicated a 1.5% overall prevalence of HIV. Factors independently associated with HIV infection were: getting tested in a large city, being illiterate, having had a previous HIV test, living with an HIV-infected sexual partner, and being a noninjection illicit drug user. Being referred by friends was strongly associated with HIV infection. For men, being a health care worker, sex worker, man who has sex with men, or injection drug user were significant. In Central Brazil, HIV remains concentrated in males and subpopulations with known risk behaviors. Higher prevalence among individuals referred to VCT by friends highlights the importance of social network-based HIV prevention interventions in Brazil.