Heterosexual Exposure Research Articles

The incidence of HIV-2 infection in Spain is declining – a registry data analysis

ObjectivesHIV-2 infection is a neglected disease caused by a human retrovirus that causes AIDS more slowly than HIV-1. Infection with HIV-2 is endemic in West Africa. Given its differential features, guidelines recommend ruling out HIV-2 infection in all newly diagnosed HIV-seropositive individuals. MethodsA national registry of HIV-2 cases was created in Spain in 1989, following the first report of three HIV-2+ individuals in Barcelona. The main demographics, clinical, and virological data are reported up to December 2023. ResultsA total of 424 individuals with HIV-2 infection were recorded in the Spanish registry. After a peak in 2009 when 31 cases were reported, new HIV-2 diagnoses steadily decreased. Less than 10 cases/year have been notified since the COVID-19 pandemic. In 2023, only eight cases were reported.Mean age at HIV-2 diagnosis was 44 years old, ranging from birth to 83 years. A total of 265 (62.5%) were male. Migrants predominated, being 322 (76%) Sub-Saharan Africans; however, 60 (14.2%) were native Spaniards. Heterosexual exposure was the most likely route of infection in at least 287 (67.7%) cases. A few cases could be traced to transfusions (n = 4), vertical infection (n = 2), or injection drug use (n = 7). In addition, 15 individuals (3.5%) were men who had sex with men. Coinfection with HIV-1 was recognized in 39 (9.2%) individuals. Molecular characterization of HIV-2 subtypes was performed in 139 individuals, 121 being infected with subtype A and 18 with subtype B. ConclusionThe annual incidence of HIV-2 infection in Spain has decreased after peaking 15 years ago, being the current number of cases below 10 per year. Three-quarters are African migrants, and two-thirds are male. Circulation of HIV-2 in Spain is limited and steadily decreasing.

How do general practitioners test and treat gonococcal infections in the Australian Capital Territory? Implications for disease surveillance and control.

The incidence of Neisseria gonorrhoeae (gonorrhoea) and Treponema pallidum (syphilis) infections in the Australian Capital Territory (ACT) has increased since 2014 in people reporting heterosexual exposure. This population is more likely to present to general practice rather than to specialised sexual health clinics, with potential implications for disease surveillance and control. This study aimed to explore: conformity of self-reported clinical practice with sexually transmitted infection guidelines in general practice; gaps in sexual health knowledge and skills; and areas for improved support from ACT Health Communicable Disease Control. A cross-sectional survey of general practitioners (GPs) and nurse practitioners (NPs) practicing in the ACT was conducted in December 2020, using a 17-item questionnaire and semi-structured interviews. Twenty-three GPs and one NP returned completed surveys (response rate 5.3%); four GPs and one NP participated in interviews. In its complex setting of competing demands, GP practice may not always meet national guidelines. In response to clinical vignettes, although all GPs ordered investigations for gonorrhoea, only 25% of these met the gold-standard by including endocervical or vaginal swabs. With respect to assessing antimicrobial sensitivities to guide treatment, only 58% correctly reported following up a positive gonococcal polymerase chain reaction test with a culture. Around two-thirds of respondents (62.5%) identified the appropriate antibiotic therapy and 75% correctly identified the responsibility of the diagnosing clinician to discuss contact tracing with the patient. Suggestions for increased support focussed on education, communication efficiency, and providing a 'safety net' for follow up.

Correlates of Casual Sex Amidst Vulnerability to HIV Among ACB Heterosexual Men in Ottawa and Windsor, Ontario Canada.

Heterosexual exposure is the second highest means of HIV transmission; and African, Caribbean, and Black (ACB) men face greater risks. Black men can reduce the disproportionately high HIV prevalence in their communities by changing their socially misconstrued masculine role. We analysed factors predisposing heterosexual ACB men to risky sexual behaviour, particularly multiple casual sex partnerships in Ottawa and Windsor, Ontario, Canada. We employed quantitative datasets from a broader mixed methods study within hierarchical logistic regression model to determine the association between psychosocial factors and casual sex partnerships. The model controlled for city level clustering effect and sociodemographic factors. Precisely 55.0% (n = 52) of men in Windsor and 70.2% (n = 99) in Ottawa had one or more casual sex partners within the past year. Some of them (Windsor, 32.1% [n = 18], and Ottawa, 34.3% [n = 36]) used condom always. HIV knowledge (OR = 0.80, p < 0.01, CI = 0.67/0.95) and pro-Black community attitudes (OR = 0.72, p < 0.05, CI = 0.56/0.94) decreased the odds of casual sex partnerships, while traditional masculinity scores (OR = 1.21, p < 0.05, CI = 1.01/1.46) increased it. The behavioural factors jointly predicted casual sex more than sociodemographic variables and city of residence. We conclude that heterosexual ACB men are predisposed to casual sex partnerships at differing magnitude across cities, and this may constitute a risk factor for HIV exposure. Hence, propagation of HIV knowledge, community attitudes and reconstruction of masculine ideology among ACB men, with due attention to geopolitical differences in city of residence, are recommended.

Análise temporal da incidência de HIV/aids em idosos no período de 2007 a 2020

Abstract Objective To analyze the temporal trend of the incidence rate of new HIV/AIDS cases in the old-aged, from 2007 to 2020, in the state of Bahia, in the Northeast Region and in Brazil. Methods Ecological time series study, using secondary data from 2007 to 2020 in an elderly population. Calculations of the HIV/AIDS incidence rate and frequency distribution of sociodemographic characteristics and exposure categories were performed. Simple linear regression models were estimated for trend analysis and calculated by the annual percentage change (APC). Results In Brazil, during the study period, there was stability in the trend of the HIV/AIDS incidence rate for the general population and for both sexes. In the Northeast there was an increase for the general (APC=6.4%), for males (APC=6.9%) and females (APC=6.5%). In Bahia, there was an increase for the general (APC=7.4%) and male sex (APC=7.4%), and stability for females. Higher proportions of new cases in the elderly were observed in males, whites (Brazil), blacks (Northeast and Bahia), low education and heterosexual exposure category. Conclusion Attention should be paid to the increase in cases in individuals in the third age seeking to demystify taboos about the sexuality of the elderly in order to promote the adoption of health promotion measures, aiming at reducing the transmission of the virus.

Profile of Acquired Immunodeficiency Syndrome (AIDS): an Epidemiological Study

Objective: To describe the profile of the population with Acquired Immunodeficiency Syndrome (AIDS) in Brazil from 2009 to 2019. Methods: This is a descriptive, quantitative study, performed with secondary data from the Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS). The analyzed data referred to cases diagnosed with Acquired Immunodeficiency Syndrome between 2009 and 2019. The variables evaluated were selected from categories, “year of diagnosis”, “sex”, “age range”, “race/skin color” and “exposure category”. Data were made available in absolute frequency, and relative frequencies were calculated in Microsoft Excel ® 2016 software. Results: It is observed that 91.14% (n=383,531) of Acquired Immunodeficiency Syndrome cases in Brazil occur in the population from 20 to 59 years. Among these, 66.44% (n= 254,840) were male and 33.55% (n=128,691) female. Since 44.97% (n=108,327) were white people; 10.93% (n=26,337) black; 0.48% (n=1.168) yellow; 43.30% (n=104.306) brown; 0.32% (n=772) indigenous. And, 24.03% (n=49,596) from homosexual exposure category; 6.40% (n=13,216) bisexual; 65.27% (n=134,703) heterosexual; 3.70% (n=7,623) UDI; 0.02% (n=48) transfusion; 0.01% (n=14) Biological material accident; 0.54 (n=1,126) vertical transmission; 0.03 (n=53) hemophiliac. Conclusion: Epidemiological profile of Acquired Immunodeficiency Syndrome in Brazil, presents a greater prevalence in male, aged from 20 to 59 years, white, posteriorly the brown race, being of heterosexual exposure category. This knowledge enables contributions to the scientific field and planning of possible public policies for the prevention and treatment of Acquired Immunodeficiency Syndrome.

Virological failure and HIV drug resistance among adults living with HIV on second-line antiretroviral therapy in the Asia-Pacific.

To assess second-line antiretroviral therapy (ART) virological failure and HIV drug resistance-associated mutations (RAMs), in support of third-line regimen planning in Asia. Adults >18years of age on second-line ART for ≥6months were eligible. Cross-sectional data on HIV viral load (VL) and genotypic resistance testing were collected or testing was conducted between July 2015 and May 2017 at 12 Asia-Pacific sites. Virological failure (VF) was defined as VL >1000 copies/mL with a second VL >1000 copies/mL within 3-6months. FASTA files were submitted to Stanford University HIV Drug Resistance Database and RAMs were compared against the IAS-USA 2019 mutations list. VF risk factors were analysed using logistic regression. Of 1378 patients, 74% were male and 70% acquired HIV through heterosexual exposure. At second-line switch, median [interquartile range (IQR)] age was 37(32-42) years and median (IQR) CD4 count was 103 (43.5-229.5) cells/µL; 93% received regimens with boosted protease inhibitors (PIs). Median duration on second line was 3years. Among 101 patients (7%) with VF, CD4 count >200 cells/µL at switch [odds ratio (OR)=0.36, 95% confidence interval (CI): 0.17-0.77 vs. CD4 ≤50) and HIV exposure through male-male sex (OR=0.32, 95% CI: 0.17-0.64 vs. heterosexual) or injecting drug use (OR=0.24, 95% CI: 0.12-0.49) were associated with reduced VF. Of 41 (41%) patients with resistance data, 80% had at least one RAM to nonnucleoside reverse transcriptase inhibitors (NNRTIs), 63% to NRTIs, and 35% to PIs. Of those with PI RAMs, 71% had two or more. There were low proportions with VF and significant RAMs in our cohort, reflecting the durability of current second-line regimens.

Incidence of tuberculosis and opportunistic respiratory infections in cases of human immunodeficiency virus: a one-year study at a tertiary care hospital

Background: Evaluation of respiratory signs and symptoms among HIV patients is a challenging task for a number of reasons. A definitive diagnosis is highly recommended before starting management protocol. Objectives of this study was to primarily evaluate the incidence of pulmonary tuberculosis and opportunistic respiratory infections among the cases of HIV and to estimate the CD4 counts of all the patients and correlate with the respiratory infections among the cases.Methods: The present study was a one-year study conducted at Narayana Medical College and all the cases of HIV presented with signs and symptoms of lower respiratory tract infections were included after obtaining consent. Relevant biochemical, microbiological investigations and CD4 counts of all the cases were done and noted. The data was entered in Microsoft excel spread sheet and analysed for any corrections. Mean, median and SD was calculated for all the continuous variables.Results: A total of 127 cases with 87 males and females 40 females with a ratio of 2.2:1 were included. Mean age of the total cases in the study was 46.12±8.3 years and 29.92% were above 60 years. Hetero sexual exposure was the commonest cause and 59.84% of cases were diagnosed with bacterial pneumonia. Prevalence of tuberculosis among the cases of this study was 22.05%. The mean CD4 cell count with SD among the study was 168.57±142.21.Conclusions: Knowledge of the pattern of pulmonary complications in patients with HIV infection in relation to CD4 count will help clinicians develop faster diagnostic and therapeutic approach to patient management.

Trends in late and advanced HIV diagnoses among migrants in Australia; implications for progress on Fast-Track targets: A retrospective observational study.

Achieving the Joint United Nations Program on human immunodeficiency virus (HIV)/AIDS Fast-Track targets requires additional strategies for mobile populations. We examined trends and socio-demographics of migrants (overseas-born) and Australian-born individuals presenting with late and advanced HIV diagnoses between 2008 and 2017 to help inform public health approaches for HIV testing coverage and linkage to care and treatment.We conducted a retrospective population-level observational study of individuals diagnosed with HIV in Australia and reported to the National HIV Registry. Annual proportional trends in late (CD4+ T-cell count <350 cells/μL) and advanced (CD4+ T-cell count <200 cells/μL). HIV diagnoses were determined using Poisson regression.Of 9926 new HIV diagnoses from 2008 to 2017, 84% (n = 8340) were included in analysis. Overall, 39% (n = 3267) of diagnoses were classified as late; 52% (n = 1688) of late diagnoses were advanced. Of 3317 diagnoses among migrants, 47% were late, versus 34% of Australian-born diagnoses (P < .001).The annual proportions of late (incidence rate ratio [IRR] 1.00; 95% confidence interval [CI] 0.99–1.01) and advanced HIV diagnoses (IRR 1.01; 95% CI 0.99–1.02) remained constant. Among migrants with late HIV diagnosis, the proportion reporting male-to-male sex exposure (IRR 1.05; 95% CI 1.03–1.08), non-English speaking (IRR 1.03; 95% CI 1.01–1.05), and individuals born in countries in low HIV-prevalence (IRR 1.02; 95% CI 1.00–1.04) increased. However, declines were noted among some migrants’ categories such as females, heterosexual exposure, English speaking, and those born in high HIV-prevalence countries.Late HIV diagnosis remains a significant public health concern in Australia. Small declines in late diagnosis among some migrant categories are offset by increases among male-to-male exposures. Reaching the Fast-Track targets in Australia will require targeted testing and linkage to care strategies for all migrant populations, especially men who have sex with men.

An expanded HIV care cascade: ART uptake, viral load suppression and comorbidity monitoring among adults living with HIV in Asia.

Comprehensive treatment and clinical management are central to improving outcomes for people living with HIV (PLHIV). We explored trends in HIV clinical care, treatment outcomes, and chronic kidney disease (CKD) and diabetes monitoring. We included patients ≥18 years in care at ten clinical sites in eight Asian countries. Proportions of patients on antiretroviral therapy (ART), with annual viral load, and with viral load suppression (VLS; <1,000 copies/ml) were estimated by year for 2011-2016, stratified by country income level (lower-middle income [LMIC] and high-income countries [HIC]). Among those on ART in 2016 we evaluated factors associated with annual CKD and diabetes monitoring. Among 31,346 patients (67% male), the proportions of patients on ART (median ART initiation year 2011, IQR 2007-2013), with annual viral load and VLS had substantially increased by 2016 (to 94%, 42% and 92%, respectively, in LMIC and 95%, 97% and 93%, respectively, in HIC) with the larger increases over time seen in LMIC. Among those on ART in 2016, monitoring proportions in LMIC were 53% for CKD and 26% for diabetes compared with 83% and 59%, respectively, in HIC. Overall, a decreased odds of monitoring was observed for male gender, heterosexual HIV exposure, no viral load and LMIC. Diabetes monitoring was also decreased in those with viral failure. Our findings highlight suboptimal monitoring of viral load, CKD and diabetes in PLHIV in Asia. There is a need for affordable and scalable monitoring options to improve the joint care for HIV and non-communicable diseases.

HIV coinfection among persons diagnosed with hepatitis B in England in 2008-2014.

The aim of the study was to estimate HIV prevalence among persons with hepatitis B virus (HBV) infection in England and to examine associated risk factors. Persons aged ≥15years with an HBV surface antigen (HBsAg) test reported to Public Health England (PHE) sentinel surveillance during 2008-2014 were linked to the PHE national HIV/AIDS database. Coinfection was defined as an HIV diagnosis prior to, or within 6months following, a positive HBsAg test. During 2008-2014, 2149933 persons were tested for HBsAg and 3.9% (1129 of 28789) of HBsAg-positive persons were HIV positive. The probable route of HIV infection was heterosexual exposure for 95.3% of female patients and 32.3% of male patients, with 61.5% of male patients reporting sex between men. Among African-born coinfected persons, 84% probably acquired HIV there. Predictors of HIV positivity included older age [adjusted odds ratio (aOR) 1.1] and being of black ethnicity (aOR 15.5 for males; aOR 16.4 for females) or being male and of white ethnicity (aOR 8.2) compared with being female and of white ethnicity. HIV coinfection was more likely when HBV was diagnosed in sexual health (aOR 55.0), specialist liver (aOR 6.7), emergency department (aOR 5.3) and renal services (aOR 2.8) compared with general practice. Most (60.4%; 682 of 1129) coinfected persons were diagnosed with HIV infection > 6months before HBV diagnosis. Persons testing positive for HBsAg had a low HIV infection rate and fell largely into two groups: those of black ethnicity with probable Africa-acquired infections and white men who have sex with men (MSM) with probable UK-acquired infections. Findings reinforce existing recommendations to sustain and improve both HBV testing of migrants from HBV-prevalent countries and vaccination among HIV-positive MSM. Findings also support blood-borne virus testing in sexual health services and emergency departments.

HIV/AIDS in South Sudan past, present, and future: a model of resilience in a challenging context

The Republic of South Sudan (RSS) is the newest state in the world which earned its independence on the 9th July 2011, following a peaceful secession from Sudan through a referendum in January 2011. In barely about 2.5 years after independence, the country ran into civil crisis starting on 15th December 2013, and refreshed in July 2016. The situation caused massive displacement and health systems disruption. The aim is to reflect on the HIV response in South Sudan despite the challenges of continued conflicts, displacement, and system disruption. Published data, as well as unpublished data available at the HIV Directorate in the Ministry of Health have been reviewed, including the HIV National Strategic plans, ANC sentinel Surveillance data, surveys and special studies, annual Health Management Information System cumulative reports from routine programmatic data (HTS, PMTCT, ART, TB/HIV, retention on care) and the UNAIDS spectrum data. The HIV epidemic in South Sudan is categorized as low and generalized (2.7%), with pockets of HIV concentration among key and vulnerable populations; who have a prevalence of 5% or more. The epidemic is thought to be widely variable across the country and geographically concentrated in the southern states of the greater Equatorial region formerly known as Western Equatoria with HIV prevalence of 6.8%, Central Equatoria 3.1%, and Eastern Equatoria 4.0%. The primary mode of infection is heterosexual exposure followed by mother-to-child transmission during pregnancy, at birth, and through breastfeeding. About 42% of the new HIV infections occurred mainly in clients of sex workers, while men and women involved in casual sexual relationships accounted for 14.5% of new infections. Female sex workers (FSWs) themselves only contributed to 11.2% of new HIV infections. Children born by HIV infected mothers accounted for 15.7%. In post conflict era in South Sudan, there is an urgent need for global initiative to conduct epidemiological studies about HIV. This will not only help peoples of South Sudan but will also increase our knowledge about how conflict and war can contribute in the spread of infectious diseases. Importantly, there are valuable lessons to learn from the South Sudan experience in terms of persistence and resilience during war and peace as HIV interventions continued to be implemented in a challenging context. Unless a strong health system is developed and sustained, building a sustainable HIV response will continue to be a challenge, and a lot more will be required.

Male urethritis with or without discharge: a clinico aetiological study in Hi-tech Medical College and Hospital Bhubaneswar, Odisha

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Urethritis or inflammation of the urethra is a multifactorial condition. Urethritis is called gonococcal urethritis (GU) when Neisseria gonorrhoeae is detected in urethral smear of the patient and nongonococcal urethritis (NGU) when this organism cannot be visualized.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Urethritis cases were identified from the dermatology OPD record. A retrospective analysis of data of patients diagnosed as GU and NGU for a period of 5 years (from August 2012-July 2017) was made. We have included only male patients more than 10 year.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Neisseria gonorrhoeae (61.42%) and Chlamydia trachomatis (45.9%) were the most common causative organism among urethritis and nongonococcal urethritis (NGU) respectively. Chlamydia urethritis had been confirmed by demonstrating ≥5 polymorphonuclear lymphocytes (PMNLs) from the anterior urethra using a Gram stained urethral smear. Acute condition (7-14 days) more common in GU. Dysuria and purulent urethral discharge (68.6%) was more common in GU. In urine specimen pus cells count were more than 10. The most common age group was 21-30 year (42.86%). Most patients were from low socio-economic status (62.85%). Sexual exposure was more common in unmarried patients (94.74%). Heterosexual exposure (93.75%) was more common. Urethritis was also associated with other infection in 18 patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Urethritis is inflammation of urethra which is manifested by dysuria with or without urethral discharge. Though there is increased incidence of Chlamydia infections, still now Gonococcal infection is the most common cause of urethritis.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Early suboptimal ART adherence was associated with missed clinical visits in HIV-infected patients in Asia

ABSTRACTMissed clinic visits can lead to poorer treatment outcomes in HIV-infected patients. Suboptimal antiretroviral therapy (ART) adherence has been linked to subsequent missed visits. Knowing the determinants of missed visits in Asian patients will allow for appropriate counselling and intervention strategies to ensure continuous engagement in care. A missed visit was defined as having no assessments within six months. Repeated measures logistic regression was used to analyse factors associated with missed visits.A total of 7100 patients were included from 12 countries in Asia with 2676 (37.7%) having at least one missed visit. Patients with early suboptimal self-reported adherence <95% were more likely to have a missed visit compared to those with adherence ≥95% (OR = 2.55, 95% CI(1.81–3.61)). Other factors associated with having a missed visit were homosexual (OR = 1.45, 95%CI(1.27–1.66)) and other modes of HIV exposure (OR = 1.48, 95%CI(1.27–1.74)) compared to heterosexual exposure; using PI-based (OR = 1.33, 95%CI(1.15–1.53) and other ART combinations (OR = 1.79, 95%CI(1.39–2.32)) compared to NRTI+NNRTI combinations; and being hepatitis C co-infected (OR = 1.27, 95%CI(1.06–1.52)). Patients aged >30 years (31–40 years OR = 0.81, 95%CI(0.73–0.89); 41–50 years OR = 0.73, 95%CI(0.64–0.83); and >50 years OR = 0.77, 95%CI(0.64–0.93)); female sex (OR = 0.81, 95%CI(0.72–0.90)); and being from upper middle (OR = 0.78, 95%CI(0.70–0.80)) or high-income countries (OR = 0.42, 95%CI(0.35–0.51)), were less likely to have missed visits.Almost 40% of our patients had a missed clinic visit. Early ART adherence was an indicator of subsequent clinic visits. Intensive counselling and adherence support should be provided at ART initiation in order to optimise long-term clinic attendance and maximise treatment outcomes.

Which Infectious Blood Donors Could Be Identified by the Donor History Questionnaire - Comparison of Blood Donors Infected with HIV or HCV with Notified Cases from General Population in Germany

Background: Potential risks for transfusion-transmissible infections are identified by donor history questionnaires (DHQs), and donors with higher risks are deferred from donation. We assessed to which extent the currently used DHQs support the identification of infections among blood donors. Methods: Between 2006 and 2013, we analyzed data from notified HIV and HCV cases in the general population and positive blood donors in Germany. Logistic regressions were used to identify relevant infection risks. We estimated the possible effect of improved capture of risk factors for donor selection by calculation of population attributable fractions (PAF). Results: Risky sexual contacts - MSM as well as heterosexual contacts - were the most prominent infection risks among HIV-infected donors. Whereas MSM contacts were significantly less reported by donors than by cases from the general population, 58% of donors disclosed heterosexual risks compared to 26% of notified cases. The complete identification of heterosexual risk contacts might prevent acceptance of 53% of HIV-infected donors. HCV-infected donors were more likely to report heterosexual exposure, imprisonment, and piercing/tattoo than notified HCV cases. Improved recording of piercing/tattoo could prevent acceptance of 16% of HCV-infected donors. Conclusion: Donor selection should be improved with special attention to the identification of (hetero)sexual risk factors, invasive procedures (piercing/tattoo and imprisonment) applying well-designed DHQs, effective donor education, and confidential environment in all steps of the selection process.

Association between male circumcision and women's biomedical health outcomes: a systematic review.

SummaryBackgroundMale circumcision reduces men’s risk of acquiring HIV and some sexually transmitted infections from heterosexual exposure, and is essential for HIV prevention in sub-Saharan Africa. Studies have also investigated associations between male circumcision and risk of acquisition of HIV and sexually transmitted infections in women. We aimed to review all evidence on associations between male circumcision and women’s health outcomes to benefit women’s health programmes.MethodsIn this systematic review we searched for peer-reviewed and grey literature publications reporting associations between male circumcision and women’s health outcomes up to April 11, 2016. All biomedical (not psychological or social) outcomes in all study types were included. Searches were not restricted by year of publication, or to sub-Saharan Africa. Publications without primary data and not in English were excluded. We extracted data and assessed evidence on each outcome as high, medium, or low consistency on the basis of agreement between publications; outcomes found in fewer than three publications were indeterminate consistency.Findings60 publications were included in our assessment. High-consistency evidence was found for five outcomes, with male circumcision protecting against cervical cancer, cervical dysplasia, herpes simplex virus type 2, chlamydia, and syphilis. Medium-consistency evidence was found for male circumcision protecting against human papillomavirus and low-risk human papillomavirus. Although the evidence shows a protective association with HIV, it was categorised as low consistency, because one trial showed an increased risk to female partners of HIV-infected men resuming sex early after male circumcision. Seven outcomes including HIV had low-consistency evidence and six were indeterminate.InterpretationScale-up of male circumcision in sub-Saharan Africa has public health implications for several outcomes in women. Evidence that female partners are at decreased risk of several diseases is highly consistent. Synergies between male circumcision and women’s health programmes should be explored.FundingUS Centers for Disease Control and Prevention and Jhpiego

A Prediction Model of Pretreatment HIV RNA Levels in Naïve Thai HIV-infected Patients: An Application for Resource-limited Settings

BackgroundThe use of abacavir (ABC) and rilpivirine (RPV) in the first-line regimen for naïve HIV-infected patients with pretreatment HIV RNA >100,000 copies/mL is not recommended due to a high rate of treatment failure. If a model could accurately predict pretreatment HIV RNA levels, it would be a useful tool for the selection ABC or RPV in the first-line regimen.MethodsThai HIV-infected adults enrolled in the TREAT Asia HIV Observational Database (TAHOD) and additional patients of Ramathibodi Hospital were eligible if they had an HIV RNA result at the time of antiretroviral therapy initiation. Factors associated with pretreatment HIV RNA <100,000 copies/mL were determined by logistic regression. Based on the results of the final model, a prediction model was created.ResultsA total of 1,223 patients were included in the analysis. Among those in the derivation data set, median [interquartile range (IQR)] age was 36.3 (30.5–42.9) years, median (IQR) CD4 count was 122 (39–216) cells/mm3, and pretreatment HIV RNA was 100,000 (32,449–229,777) copies/mL. Factors associated with pretreatment HIV RNA <100,000 copies/mL were anemia [odds ratio (OR) 2.05 vs. no anemia; 95% confidence interval (CI) 1.28–3.27], CD4 count >200 cells/mm3 (OR 3.00 vs. CD4 count <200 cells/mm3; 95% CI 2.08–4.33), and non-heterosexual HIV exposure (OR 1.61 vs. heterosexual HIV exposure; 95% CI 1.07–2.43). No AIDS-defining illness (11.5), no anemia (18.5), age <35 years (11), CD4 count >200 cells/mm3 (27), duration of HIV infection >1 year (9), and weight >50 years (11) were included in the clinical prediction tool scores. A score ≥45 yielded a sensitivity of 45.3%, specificity of 76.7%, positive predictive value of 68.1%, and negative predictive value of 56.1% among patients in the derivation. The area under the receiver-operator characteristic curve was 0.655 (95% CI 0.614- 0.696) and 0.600 (95% CI 0.533–0.667) in the derivation and validation patients, respectively.ConclusionOur final prediction model had poor sensitivity and specificity for predicting HIV RNA <100,000 copies/mL. Further study on a larger population with a greater diversity of data variables available is necessary to improve the model. Pretreatment HIV RNA remains necessary before ABC or RPV initiation for naïve Thai HIV-infected patients.Disclosures All authors: No reported disclosures.

SIXTY AND SEXY: FACTORS INFLUENCING HIV RISK-TAKING BEHAVIORS AMONG OLDER AFRICAN-AMERICAN WOMEN

Despite myths and stereotypes, many older women are sexually active. Among older African American women, rates are increasing for newly-diagnosed HIV infection, for those living with HIV and for HIV/AIDS-related mortality. While African American women represent only 14% of the U.S. female population, they account for nearly two-thirds of all new HIV infections in women and for over half with AIDS. Although many health promotion/disease prevention (HP/DP) efforts are directed toward HIV risk-reduction for younger African-American women, less notice is directed toward their sexually active, older counterparts. Yet, the primary mode of transmission for both is high risk heterosexual exposure. Does a one-size-fits-all prevention approach work for all African American women? Or, is it necessary to customize interventions for older African-American women because of unique factors influencing their risky sexual behaviors? This inquiry explored whether early gender socialization and the establishment of gender norms and roles in a very different social era impact their current risk-taking sexual behaviors. Surveys and focus groups were used to elicit values, beliefs, attitudes, gender role expectations and knowledge in relationship to high risk sexual behaviors. The results highlighted the need to tailor HIV prevention interventions that are socially- and culturally-relevant and appropriate for the priority population of older African American women. The resulting intervention design takes into account overcoming long-held gender roles/norms and positively impacts their knowledge, attitudes and behaviors that in turn empowers them to protect their health, practice healthy sexual behaviors and to improve their overall quality of life.

HIV-AIDS patients with respiratory manifestation: study at tertiary care center

Background: HIV affects virtually all organ systems in the body. Pulmonary disease is one of the most frequent complications of HIV infection. It is found in mostly married, young and middle aged, urban poor with male preponderance and heterosexual and blood transfusion being the commonest source of infection. Prompt diagnosis and early management may hasten the clinical recovery and reduce the risk and severity of toxic drug effects. Moreover knowledge regarding the incidence and early manifestations may help in developing strategies regarding prophylactic therapy of various infections of respiratory system. Aim of this study was to find the Incidence, occurrence and pattern of respiratory infections in HIV infected patients, use of various drugs used and response of therapy in respiratory infections and to study impact of HAART in PLHA with respiratory infection. Methods: Fifty HIV infected patients showing clinical evidence of respiratory system involvement and admitted in our hospital from May 2014 to November 2015 were studied in present study. Clinical history was noted and detailed physical examination, laboratory evaluation and specialized tests were carried out in all patients looking especially for presence of associated opportunistic infections in other systems.Results: Cough and dyspnea were the prominent respiratory symptoms and commonest sign was consolidation (42%) and effusion (24%) or no respiratory signs (26%).Tuberculosis (66%) followed by bacterial pneumonia (24%) including recurrent bacterial pneumonia (6%), PCP (8%) and fungal infection (2%), were the commonest respiratory manifestations. Commonest organisms isolated in bacterial pneumonia were Streptococcus Pneumonia, Staph aureus and Klebsiella. Incidence of pulmonary TB was 66%. PCP was found in 8% of cases. HAART combination of lamivudine, stavudine and nevirapine were found efficacious, safe and well tolerated when combined with other antibiotics and/or AKT.Conclusions: Heterosexual exposure (70%) and blood borne infection (18%) were commonest route of infection. Fever and weight loss was commonest presenting constitutional symptoms and all patients either belonged to B or C category.

Smoking and projected cardiovascular risk in an HIV-positive Asian regional cohort.

The aim of the study was to assess the prevalence and characteristics associated with current smoking in an Asian HIV-positive cohort, to calculate the predictive risks of cardiovascular disease (CVD), coronary heart disease (CHD) and myocardial infarction (MI), and to identify the impact that simulated interventions may have. Logistic regression analysis was used to distinguish associated current smoking characteristics. Five-year predictive risks of CVD, CHD and MI and the impact of simulated interventions were calculated utilizing the Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) algorithm. Smoking status data were collected from 4274 participants and 1496 of these had sufficient data for simulated intervention calculations. Current smoking prevalence in these two groups was similar (23.2% vs. 19.9%, respectively). Characteristics associated with current smoking included age >50years compared with 30-39years [odds ratio (OR) 0.65; 95% confidence interval (CI) 0.51-0.83], HIV exposure through injecting drug use compared with heterosexual exposure (OR 3.03; 95% CI 2.25-4.07), and receiving antiretroviral therapy (ART) at study sites in Singapore, South Korea, Malaysia, Japan and Vietnam in comparison to Thailand (all OR>2). Women were less likely to smoke than men (OR 0.11; 95% CI 0.08-0.14). In simulated interventions, smoking cessation demonstrated the greatest impact in reducing CVD and CHD risk and closely approximated the impact of switching from abacavir to an alternate antiretroviral in the reduction of 5-year MI risk. Multiple interventions could reduce CVD, CHD and MI risk in Asian HIV-positive patients, with smoking cessation potentially being the most influential.

Molecular epidemiology identifies HIV transmission networks associated with younger age and heterosexual exposure among Korean individuals.

To evaluate if HIV transmission networks could be elucidated from data collected in a short time frame, 131 HIV-1 pol sequences were analyzed which were generated from treatment-naïve Korean individuals who were sequentially identified over 1 year. A transmission linkage was inferred when there was a genetic distance <1.5% and a total of 16 clusters, involving 39/131 (29.8%), were identified. Younger age and heterosexual exposure were independently related with clustering in the inferred network, which demonstrated that molecular epidemiology with currently generated data (i.e., drug resistance genotypes) can be used to identify local transmission networks, even over a short timeframe. J. Med. Virol. 88:1832-1835, 2016. © 2016 Wiley Periodicals, Inc.