High Prevalence Of Human Immunodeficiency Virus Infection Research Articles

Prevalence of HIV Infection in Pregnant Women Attending Ante Natal Care at Lugbe Clinic, Abuja, Federal Capital Territory: A 3-Year Retrospective Study

This is a 3-year (2019 -2021) retrospective study of Human Immunodeficiency Virus (HIV) infection in pregnant women attending Lugbe clinic for ante natal care. Of the 4, 023 pregnant women that attended the clinic for Anti Natal Care (ANC) during this period, 3818 that have complete information in their files were enlisted for the study. Overall prevalence of HIV in the pregnant women was 2.7% (102/3818). Yearly prevalence of 1.6% (21/1329), 3.0% (36/1196) and 3.5% (45/1293) in 2019, 2020 and 2021 respectively were obtained. There was no statistical significance (p>0.05) in the prevalence of HIV among pregnant women in the period under study. The highest prevalence rate of 38.2% was observed in the age category of 29–33 years. Monthly trend analysis of the prevalence showed infection was highest in July, 2020. Pregnant women with secondary school level of education had the highest prevalence, 4.4% (20/454). This study revealed that divorcees had the highest prevalence of 3.5% (43/1243). There was no significant (p>0.05) difference in the infection rate of 2.7% (57/2109) with primigravids compared to multigravida 2.6% (45/1709). This result further showed that pregnant women in polygamous marriages had higher prevalence of HIV infection, 3.5% (56/1596) compared to monogamous ones, 2.1% (46/2222). Differences in employment status of the subjects under study revealed that unemployed pregnant women had higher prevalence of HIV, 3.3% (60/1979) than those employed, 2.1% (42/1979). The increased prevalence of HIV in pregnant women in this study is an indication of declining impact of campaign against the scourge of HIV especially in FCT. There is therefore need for a change in the strategy to minimize or stop the spread of this disease.

Monkeypox Patients Living with HIV: A Systematic Review and Meta-Analysis of Geographic and Temporal Variations.

This index meta-analysis estimated the pooled prevalence of human immunodeficiency virus (HIV) among individuals with monkeypox (mpox) globally. We searched seven databases: PubMed, Scopus, Web of Science, EMBASE, ProQuest, EBSCOHost, and Cochrane, for human studies published in English till 4 January 2023, as per International Prospective Register of Systematic Reviews (PROSPERO) registration protocol (CRD42022383275). A random effects regression model was used to estimate the pooled prevalence owing to high heterogeneity. The risk of bias in the included studies was assessed using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool. The systematic search yielded 677 articles; finally, 32 studies were found eligible for systematic review and 29 studies for meta-analysis. The pooled prevalence of HIV infection was 41% (95% confidence interval [CI], 35-48). All studies were rated as fair or good quality. Studies from Europe and North America reported a high prevalence of HIV infection among individuals with mpox- 41% (95% CI 33-49) and 52% (95% CI 28-76), respectively, while studies from Nigeria, Africa reported a relatively low prevalence of HIV infection of 21% (95% CI 15-26). A history of sexual orientation and sexual partners in the last 21 days must be taken from individuals with mpox to identify the potential source and contacts for quarantining and testing them.

Prevalence of and risk factors for Human Immunodeficiency Virus (HIV) infection in entrants and residents of an Ethiopian prison.

Prisoners generally have a higher prevalence of HIV infection compared to the general population from which they come. Whether this higher prevalence reflects a higher HIV prevalence in those entering prisons or intramural transmission of HIV within prisons or both is unclear. Any of these possibilities would increase the prevalence found in resident prisoners above that in the general population. Moreover, comparisons of HIV prevalence in entrants and residents and in men and women in African prisons are not well documented. The purpose of this study was to estimate and compare the prevalence and risk factors for HIV infection amongst both male as well as female and entrant and resident prisoners in a large Ethiopian Federal Prison. We studied consenting prisoners cross-sectionally from August 2014 through November 2016. Prison entrants were screened continuously for HIV infection and its associated risk factors and residents were screened in two waves one year apart. HIV was diagnosed at the prison hospital laboratory based on the Ethiopian national HIV rapid antibody testing protocol. An external, internationally-accredited reference laboratory confirmed results. Agreement of results between the laboratories were assessed. A total of 10,778 participants were screened for HIV. Most participants were young (median age of 26 years, IQR: 21-33), male (84%), single (61%), literate (89%), and urban residents (91%) without prior incarceration (96%). Prevalence of HIV was 3.4% overall. Rates of HIV (p = 0.80) were similar in residents and entrants in wave 1 and in entrants in both waves, but were 1.9-fold higher (5.4% vs 2.8%) in residents than entrants in wave 2 (both p<0.001). At entrance to the prison women were more likely to be HIV+ than men (5.5% in women vs 2.5% in men, p< 0.001). In contrast resident women were less likely to be HIV+, but this difference was not statistically significant (3.2% in women vs 4.3% in men, p = 0.125). Other risk factors associated with HIV infection were increasing age (p<0.001), female gender (p<0.001), marital status (never vs other categories, p = 0.016), smaller number of rooms in their houses pre-imprisonment (p = 0.031), TB diagnosis ever (p<0.001), number of lifetime sex partners (especially having 2-10, p<0.001), and genital ulcer (p = 0.037). Prevalence of HIV in the residents at this large, central Ethiopian prison was higher than that estimated for the general population and lower than in many other studies from other smaller Ethiopian prisons. A higher prevalence in residents than in entrants were found only in our second wave of screening after one year of continuous screening and treatment, possibly representing increased willingness of residents at increased risk of HIV to participate in the second wave. Thus, this findings did not clearly support intramural transmission of HIV or the effectiveness of screening to reduce prevalence. Finally, the higher HIV prevalence in women than men requires that they be similarly screened and treated for HIV infection.

Trend of HIV Infection and Associated Risk Factors at Integrated Counselling and Testing Centre in a Tertiary Care Hospital in Bihar: A Retrospective Study

Introduction: Human Immunodeficiency Virus (HIV) infection became a major global health issue and a priority in many countries because it is the leading cause of morbidity and mortality throughout the world. In India, about 71% of total annual new HIV infections were reported from Telangana, Bihar, West Bengal, Uttar Pradesh, Andhra Pradesh, Maharashtra, Karnataka, Gujrat, Tamil Nadu and Delhi. The major cause of concern is that around 25% of the infected people are not aware that they are infected by HIV virus and is one of the major risk factor responsible for the spread of HIV infection. Aim: To evaluate the trends, pattern and associated risk factors responsible for the spread of Human Immunodeficiency Virus (HIV) infection in patients who attended Integrated Counselling and Testing Centre (ICTC) of a tertiary care centre of Bihar, India. Materials and Methods: A retrospective study was conducted on the available records of all the patients who attended ICTC of a tertiary care centre in Bihar, India, between January 2016 to December 2018. The data regarding the age, sex, marital status, educational status and behavioural pattern of the patients tested for HIV infection at the ICTC were assessed and analysed. Descriptive statistical analysis was done. Results: The total of 16333 and 15969 patients received counselling and testing services respectively during the study period. The prevalence of HIV infection was 3.70%, amongst whom 64.38% were males and 32.93% were females including 2.69% pregnant female patients. The ratio of seropositive male to seropositive female was 2.07:1. Maximum seroreactivity was found in 35-49 years age group (38.57%) followed by 25-34 years age group (28.42%). The major factor for the transmission and spread of HIV infection was unprotected sexual contact (88.33%) followed by mother to child transmission, infected blood and its products and infected needles and syringes. Illiteracy (45%) and unawareness was the major associated factor for spread of HIV infection. Conclusion: The high prevalence of HIV infection can be minimised by creating awareness, following safe sexual practices, promoting antenatal screening, procuring blood and its product from authorised blood banks where proper screening of Transfusion Transmitted Infections (TTI) is done.

High Prevalence of Human Immunodeficiency Virus Infection among Inmates in Korean Correctional Facilities.

BackgroundEpidemiological data are crucial in designing policies for the control of human immunodeficiency virus (HIV) infections. There is a lack of data on the epidemiology of HIV in Korean correctional facilities such as jails and prisons.MethodsClinical characteristics of the study population were collected through a medical record review.ResultsThe number of people with HIV infection were 83 and the HIV infection prevalence in correctional facilities of Korea was 0.15%. Among them, 10 (12.0%) were diagnosed with the infection when they were incarcerated. The number of drug users was 38 (45.8%). Syphilis-HIV coinfection was observed in 21 (25.3%) patients. Individuals from the group comprising the drug users were more likely to belong to the lesbian, gay, bisexual, transgender, queer (LGBTQ) community, and had a higher incidence of psychological disorders (31.6% vs. 11.1%, P = 0.029; 50.0% vs. 28.9%, P = 0.049, respectively).ConclusionInmates of correctional facilities showed a five times higher prevalence of HIV infection in Korea, nearly half of whom were drug users.

Changes in the incidence and prevalence of human immunodeficiency virus or acquired immunodeficiency syndrome in the South African medical schemes environment: 2005-2015.

BackgroundThe South African (SA) private medical schemes environment has over the past two decades respond to the evolving needs of people living with the human immunodeficiency virus (PLWH) or acquired immunodeficiency syndrome (AIDS).ObjectiveTo determine changes in the incidence and prevalence rate of human immunodeficiency virus (HIV) or AIDS in the SA private medical schemes environment from 2005 to 2015.MethodIn this observational study, a single, pharmaceutical benefit management (PBM) company’s medicine-claims database of members with HIV or AIDS has been retrospectively analysed from January 2005 to December 2015. The cohort includes all patients identified by the HIV or AIDS-related diagnostic ICD-10 codes, B20-B24, who also claimed antiretroviral medication during that period.ResultsFrom 2005 to 2015, the proportion of HIV or AIDS patients enrolled in the PBM-company increased from 0.63% to 2.10%, and the incidence rate of new cases among the beneficiaries increased 2.3 times. The highest HIV or AIDS prevalence and incidence rates were found in the age group ≥ 40 and < 60 years, followed by the age group ≥ 60 and < 70 years. The highest prevalence rates in 2015 were recorded in Gauteng, namely, 422.4/1000 beneficiaries, followed by Western Cape (149.4/1000), and KwaZulu-Natal (118.4/1000).ConclusionThere has been an increase in the number of SA-PLWH accessing treatment in the medical scheme environment. The high prevalence of HIV infection among older members should signal concern that HIV-related comorbid conditions are likely to become a growing component of care required by PLWH utilizing the SA private healthcare sector.

Outbreak of Listeriosis in South Africa Associated with Processed Meat

BackgroundAn outbreak of listeriosis was identified in South Africa in 2017. The source was unknown.MethodsWe conducted epidemiologic, trace-back, and environmental investigations and used whole-genome sequencing to type Listeria monocytogenes isolates. A case was defined as laboratory-confirmed L. monocytogenes infection during the period from June 11, 2017, to April 7, 2018.ResultsA total of 937 cases were identified, of which 465 (50%) were associated with pregnancy; 406 of the pregnancy-associated cases (87%) occurred in neonates. Of the 937 cases, 229 (24%) occurred in patients 15 to 49 years of age (excluding those who were pregnant). Among the patients in whom human immunodeficiency virus (HIV) status was known, 38% of those with pregnancy-associated cases (77 of 204) and 46% of the remaining patients (97 of 211) were infected with HIV. Among 728 patients with a known outcome, 193 (27%) died. Clinical isolates from 609 patients were sequenced, and 567 (93%) were identified as sequence type 6 (ST6). In a case–control analysis, patients with ST6 infections were more likely to have eaten polony (a ready-to-eat processed meat) than those with non-ST6 infections (odds ratio, 8.55; 95% confidence interval, 1.66 to 43.35). Polony and environmental samples also yielded ST6 isolates, which, together with the isolates from the patients, belonged to the same core-genome multilocus sequence typing cluster with no more than 4 allelic differences; these findings showed that polony produced at a single facility was the outbreak source. A recall of ready-to-eat processed meat products from this facility was associated with a rapid decline in the incidence of L. monocytogenes ST6 infections.ConclusionsThis investigation showed that in a middle-income country with a high prevalence of HIV infection, L. monocytogenes caused disproportionate illness among pregnant girls and women and HIV-infected persons. Whole-genome sequencing facilitated the detection of the outbreak and guided the trace-back investigations that led to the identification of the source.

Sociodemographic and Clinical Characteristics of Highly Active Antiretroviral Treatment-Naïve Human Immunodeficiency Virus-Seropositive Patients in Uyo, Nigeria: Are the Demographics Changing?

Background:Human immunodeficiency virus (HIV) infection poses a great health and economic burden, especially in developing nations where a high burden of disease has been described. A previous study in Uyo shows that some characteristics associated with a higher prevalence of HIV infection include female gender, exposure to tertiary level of education, and late disease presentation. This study aimed at determining the sociodemographic and the clinical characteristics of highly active antiretroviral treatment-naïve (HAART-naïve) HIV-seropositive patients at Uyo, Nigeria.Materials and Methods:This was a cross-sectional comparative study of 210 respondents, composed of 105 HAART-naïve HIV-seropositive patients (subjects) and an equal number of sex- and age-matched HIV-negative individuals (controls). Data were collected using pretested interviewer-administered questionnaires and hospital records. Anthropometry and blood pressure (BP) were measured for all the respondents, while clinical and immunologic staging were done for subjects. Data obtained were analyzed using SPSS v 20. P ≤ 0.05 was taken as statistically significant.Results:The mean age of the respondents was 34.5 ± 9.2 years, and the male-to-female ratio was 1:2.3, with no difference between the subjects and controls (P = 0.880 for age and P = 0.943 for gender). Mean body mass index and mean diastolic BP were significantly lower in the subjects (P < 0.001 and 0.037, respectively). Female gender, secondary level of educational attainment, and unskilled employment were significantly associated with HIV infection. Majority of the respondents presented in clinical Stage 1 or 2 disease, with CD4 count >350 cells/ml.Conclusion:The burden of HIV infection is higher in females and in those with sociodemographic characteristics suggestive of lower socioeconomic status, however, majority of these appeared to present in early disease.

Use of a Sentinel Lymph Node Biopsy Algorithm in a South African Population of Patients With Cervical Cancer and High Prevalence of Human Immunodeficiency Virus Infection.

Cervical cancer is common in resource-poor settings with high prevalence of tuberculosis, pelvic inflammatory disease, and human immunodeficiency virus (HIV) infection. There are no data regarding the sentinel lymph node (SLN) algorithm in these high-risk cancer populations. Our objectives were to establish the sensitivity, specificity, positive predictive value, and negative predictive value of the SLN algorithm in cervical cancer and to compare the detection rate of indocyanine green (ICG) versus blue dye versus technetium Tc 99m nanocolloid (Tc). This prospective study was conducted at the University of Pretoria. Tc-nanocolloid tracer, ICG dye, and methylene blue (MB) were used to detect SLNs. Pathological ultrastaging was performed on hematoxylin-eosin- negative nodes. Results of 72 women were analyzed. The mean age was 47.2 years, 5.5% had a history of tuberculosis, 18.1% had pelvic inflammatory disease, and 65.3% were HIV positive. The SLN detection rate was 65.3%. Detection rate of MB was 56.9%; Tc, 69.4%; ICG, 87.5%; and the combination of MB and Tc, 91.7%. Pelvic nodal metastases occurred in 26.4%. The sensitivity, specificity, negative predictive value, and positive predictive value of SLN biopsy were 85.7%, 100%, 100%, and 98.33%, respectively. The false-negative rate was 14.3%, and it was 0% if the algorithm was applied. The SLN algorithm is a feasible option for use in cervical cancer women with a high prevalence of HIV infection. The detection rate is generally lower, but in select subgroups of women, it was comparable to that reported elsewhere. This is the first report of the use of SLN biopsy in a substantial group of HIV-infected women.

Human immunodeficiency virus (HIV) infection in men with penile carcinoma is associated with increased prevalence of human papilloma virus infection and younger age at presentation

We investigated the prevalence of HIV and human papilloma virus (HPV) infection in men with penile carcinoma. This retrospective study investigated all men with penile carcinoma at the Universitas Academic Hospital in Bloemfontein, South Africa (January 2000-December 2008). Patients' age, HIV status, histological type of carcinoma and evidence of HPV infection were recorded. Statistical analyses included Student's t-test and Fisher's exact test where appropriate (2-tailed p-value < 0.05 indicated statistical significant). Among 65 patients (mean age 50.9 years, range 37-69), the most common histological type was squamous cell carcinoma (80.0%). HIV status was known for 48 patients; 27 (56.2%) were HIV-positive. The mean age at presentation was 43.7 years (range 26-69) years in the HIV-positive and 57.2 years (range 26-89) years in the HIV-negative group. Approximately 55% of HIV-positive and 24% of HIV-negative patients showed histological evidence of HPV infection (p = 0.04). No significant difference was found with regard to histological type of carcinoma. Patients with penile carcinoma had a high prevalence of HIV infection. The HIV-positive group were significantly younger at presentation, with a higher prevalence of HPV infection, suggesting that HIV may contribute to HPV-associated penile cancer at a younger age.

Respiratory Virus–Associated Severe Acute Respiratory Illness and Viral Clustering in Malawian Children in a Setting With a High Prevalence of HIV Infection, Malaria, and Malnutrition

BackgroundWe used data from 4 years of pediatric severe acute respiratory illness (SARI) sentinel surveillance in Blantyre, Malawi, to identify factors associated with clinical severity and coviral clustering.MethodsFrom January 2011 to December 2014, 2363 children aged 3 months to 14 years presenting to the hospital with SARI were enrolled. Nasopharyngeal aspirates were tested for influenza virus and other respiratory viruses. We assessed risk factors for clinical severity and conducted clustering analysis to identify viral clusters in children with viral codetection.ResultsHospital-attended influenza virus–positive SARI incidence was 2.0 cases per 10 000 children annually; it was highest among children aged <1 year (6.3 cases per 10 000), and human immunodeficiency virus (HIV)–infected children aged 5–9 years (6.0 cases per 10 000). A total of 605 SARI cases (26.8%) had warning signs, which were positively associated with HIV infection (adjusted risk ratio [aRR], 2.4; 95% confidence interval [CI], 1.4–3.9), respiratory syncytial virus infection (aRR, 1.9; 95% CI, 1.3–3.0) and rainy season (aRR, 2.4; 95% CI, 1.6–3.8). We identified 6 coviral clusters; 1 cluster was associated with SARI with warning signs.ConclusionsInfluenza vaccination may benefit young children and HIV-infected children in this setting. Viral clustering may be associated with SARI severity; its assessment should be included in routine SARI surveillance.

Unrecognized human immunodeficiency virus infection and risk factors among elderly medical patients at the Korle Bu teaching hospital, Accra, Ghana.

BackgroundThe human immunodeficiency virus (HIV) infection usually infects persons in the reproductive age group (15–49 years), but elderly people are also susceptible. Many people in sub-Saharan Africa including Ghana believe that elderly people are not at risk for HIV. Despite numerous reports of the high prevalence of HIV infection among the elderly worldwide, there are no from Ghana. This work determined the sero-prevalence of HIV infection and risk factors for its transmission among 1,100 hospitalized elderly people at the Korle Bu Teaching Hospital (KBTH), Accra, Ghana.MethodsSubjects voluntarily completed a risk-factor questionnaire and provided a blood specimen for HIV testing.ResultsOf the study participants, 440 were male (mean age: 64 ± 10.55 years), and 660 were female (mean age: 63 ± 9.51 years). The overall HIV-1 sero-prevalence among the subjects was 4.18 % (n = 46). On multivariate analysis, there was no statistical significance between the socio-demographics or risk factors and the HIV status of the participants.ConclusionThe results suggest high prevalence of HIV-1 among hospitalized elderly people at KBTH, recommending the need to include the elderly in HIV/AIDS testing, prevention, and control programmes.Trial registrationTrial registration number: MS-Et/M.9 - p4.10/2012–2013. Registered: 10th April, 2013.

Transmission of tuberculosis in a South African community with a high prevalence of HIV infection.

In settings of high tuberculosis transmission, little is known of the interaction between human immunodeficiency virus (HIV) positive and HIV-negative tuberculosis disease and of the impact of antiretroviral treatment (ART) programs on tuberculosis transmission dynamics. Mycobacterium tuberculosis isolates were collected from patients with tuberculosis who resided in a South African township with a high burden of tuberculosis and HIV infection. Demographic and clinical data were extracted from clinic records. Isolates underwent IS6110-based restriction fragment length polymorphism analysis. Patients with unique (nonclustered) M. tuberculosis genotypes and cluster index cases (ie, the first tuberculosis case in a cluster) were defined as having tuberculosis due to reactivation of latent M. tuberculosis infection. Secondary cases in clusters were defined as having tuberculosis due to recent M. tuberculosis infection. Overall, 311 M. tuberculosis genotypes were identified among 718 isolates from 710 patients; 224 (31%) isolates were unique strains, and 478 (67%) occurred in 87 clusters. Cluster index cases were significantly more likely than other tuberculosis cases to be HIV negative. HIV-positive patients were more likely to be secondary cases (P = .001), including patients receiving ART (P = .004). Only 8% of cases of adult-adult transmission of tuberculosis occurred on shared residential plots. Recent infection accounted for the majority of tuberculosis cases, particularly among HIV-positive patients, including patients receiving ART. HIV-negative patients may be disproportionally responsible for ongoing transmission.

Risk factors for necrotising enterocolitis in an HIV-endemic region

Background:Several risk factors have been implicated in the development of necrotising enterocolitis (NEC). However, little has been reported on the risk factors for NEC in infants born in a setting where exposure to maternal human immunodeficiency virus (HIV) is prevalent.Objectives:To determine maternal and infant characteristics associated with NEC in a setting with a high prevalence of HIV infection and to compare clinical presentation and mortality of NEC in HIV-exposed and unexposed infants.Methods:This was a retrospective, case-control study. Infants with a confirmed diagnosis of NEC, admitted between January 2005 and December 2008 were identified as cases. Two controls for each case were selected by matching them for birthweight, gestational age and date of birth. Hospital records were reviewed for maternal and infant characteristics.Results:One hundred and ten infants with confirmed NEC were identified and 220 were selected as controls. Median birthweight and gestational age were similar between cases and controls, (1370 and 1380 g, P = 0·96, and 31 weeks each, P = 0·62, respectively). Lack of use of antenatal corticosteroids (ANS) (OR 2·77, 95% CI 1·42–5·38, P = 0·003), presence of chorio-amnionitis (OR 7·28, 95% CI 2·16–24·51, P = 0·001) and not mechanically ventilated at birth (OR 3·54, 95% CI 1·29–9·69, P = 0·01) were independently associated with NEC. Maternal HIV status was not associated with NEC. Clinical presentation and mortality from NEC were similar between HIV-exposed and unexposed infants.Conclusions:Infants who develop NEC were less likely to have received mechanical ventilation at birth, suggesting that they were less critically ill when born. Use of ANS should be encouraged as it is protective against NEC. Infants born to HIV-infected mothers were not at increased risk of NEC.

Voluntary Counseling and Testing in the Pediatric Ward of Mzuzu Central Hospital, Northern Malawi

ObjectivesA voluntary counseling and testing (VCT) program to screen for human immunodeficiency virus (HIV) has been implemented in areas of high HIV prevalence; however, such services are not readily available to children in the clinics of sub-Saharan Africa. The objective of this study was to investigate the relationship between the clinical symptoms of children and HIV infection status. MethodsA cross-sectional study of children and their caregivers was conducted at a clinic in northern Malawi, a country with a high prevalence of HIV infection. A total of 85 (48.6%) pediatric patients and 82 (46.7%) caregivers were recruited in the study. The HIV VCT services were provided based on the principle of three C’s (consent, counseling, and confidential). ResultsThe prevalence rates of HIV infection were 16.5% for children and 25.9% for their caregivers. In those children, 74.0% and 65.3% of HIV infections may be attributable to malnutrition and sepsis, respectively. Caregivers were mainly motivated to accept the VCT service or agree to have their children receive the test because they wanted to know their own HIV status (81.7%) and the status of their children (78.0%). ConclusionWhen a child shows symptoms of malnutrition and sepsis, the clinic should recommend VCT to caregivers in order to help them learn about their own as well as their child’s HIV status. After discussing factors that affect the advantages, disadvantages, limitations, and acceptability of offering routine VCT services, it is concluded that a standard approach to identify HIV infections in hospitalized children is urgently needed.

Identifying high-risk areas for sporadic measles outbreaks: lessons from South Africa

To develop a model for identifying areas at high risk for sporadic measles outbreaks based on an analysis of factors associated with a national outbreak in South Africa between 2009 and 2011. Data on cases occurring before and during the national outbreak were obtained from the South African measles surveillance programme, and data on measles immunization and population size, from the District Health Information System. A Bayesian hierarchical Poisson model was used to investigate the association between the risk of measles in infants in a district and first-dose vaccination coverage, population density, background prevalence of human immunodeficiency virus (HIV) infection and expected failure of seroconversion. Model projections were used to identify emerging high-risk areas in 2012. A clear spatial pattern of high-risk areas was noted, with many interconnected (i.e. neighbouring) areas. An increased risk of measles outbreak was significantly associated with both the preceding build-up of a susceptible population and population density. The risk was also elevated when more than 20% of infants in a populous area had missed a first vaccine dose. The model was able to identify areas at high risk of experiencing a measles outbreak in 2012 and where additional preventive measures could be undertaken. The South African measles outbreak was associated with the build-up of a susceptible population (owing to poor vaccine coverage), high prevalence of HIV infection and high population density. The predictive model developed could be applied to other settings susceptible to sporadic outbreaks of measles and other vaccine-preventable diseases.

Male Out-Migration: A Factor for the Spread of HIV Infection among Married Men and Women in Rural India

IntroductionThus far, the reasons for increasing HIV prevalence in northern and eastern Indian states are unknown. We investigated the role of male out-migration in the spread of human immunodeficiency virus (HIV) infection through a case-control study in rural India.MethodsCurrently married men and women were recruited from HIV testing and treatment centers across seven selected districts with high rates of male out-migration in eastern and northern India in 2010 using a case-control study design. Case subjects (men: 595, women: 609) were people who tested HIV seropositive and control subjects (men: 611, women: 600) were those tested HIV seronegative. For each gender, we obtained adjusted odds ratios (AORs) and population attributable risks (PARs) for migration, and behavioral factors.ResultsFor men, the prevalence of HIV was significantly higher among those with a migration history (AOR, 4·4); for women, the prevalence of HIV was higher among those with migrant husbands (AOR, 2·3). For both genders, the returned male migration (men: AOR, 3·7; women: AOR, 2·8) was significantly associated with higher prevalence of HIV infection. The PAR associated with male migration was higher for men (54·5%–68·6%) than for women (32·7%–56·9%) across the study areas.DiscussionMale out-migration is the most important risk factor influencing the spread of HIV infection in rural areas with high out-migration rates, thereby emphasizing the need for interventions, particularly, for returned migrants and spouses of those migrants.

Seroepidemiology of human immunodeficiency virus in illicit substance users in Ahvaz, Iran: 2005-2006

: Background: A high seroprevalence rate of human immunodeficiency virus (HIV) infection has been reported among Iranian illicit substance users (ISUs).Objectives: The aim of this study was to evaluate the prevalence of HIV and its risk factors in this population.Patients and Methods: A total of 228 ISUs were included in this cross-sectional study, which was conducted in Ahvaz, southern Iran, from 2005 to 2006. The study population was randomly selected from available ISUs in prisons and addiction treatment centers. Subjects were tested for the presence of anti-HIV antibodies using the enzyme linked immunosorbent assay (ELISA) method. Drug use behaviors associated with HIV transmission (i.e., high-risk behaviors) and their current sexual risk behaviors were examined.Results: Sixty two (27.2 %; 95 % CI: 22.5 % - 31.8 %) of the 228 men were HIV positive. The prevalence of HIV positivity in injecting, inhalant and oral users was 50.2 %, 10.4 %, and 7.6 %, respectively. HIV was positive in heroin, crack and opium users with a rate of 96.2 %, 83.3 %, and 1.4 %, respectively. Among the HIV infected cases, the vast majority had engaged in high-risk behaviors, including sharing needles (72 %), the majority of the injectors had also had unprotected sex with women (67.7 %), or with men (22.6 %).Conclusions: Illicit substance usage is associated with an increased risk of exposure to HIV and this results in a high prevalence of HIV infection. Heroin injecting, sexually transmitted diseases (STD), having sex with multiple partners, unprotected sex, a long period in prison, early adulthood, and family contact with HIV infected cases, are considered to be the main risk factors for HIV infection. Implication for health policy/practice/research/medical education:The results of this study are useful for health policy in HIV control.Please cite this paper as:Alavi SM, Nadimi M, Shokri S, Zamani G. Seroepidemiology of Human Immunodeficiency Virus in Illicit Substance Users in Ahvaz, Iran: 2005-2006. Jundishapur J Microbiol. 2012;5(3):474-8. DOI: 10.5812/jjm.3446 Copyright © 2012 Kowsar Corp. All rights reserved.

Acquired Epidermodysplasia Verruciformis Due to Multiple and Unusual HPV Infection Among Vertically-Infected, HIV-Positive Adolescents in Zimbabwe

We have previously described the presentation of epidermodysplasia verruciformis (EV)-like eruptions in almost a quarter of hospitalized adolescents with vertically-acquired human immunodeficiency virus (HIV) infection in Harare, Zimbabwe, a region with a high prevalence of HIV infection. We performed a clinical case note review and skin biopsy from affected sites in 4 HIV-infected adolescents with EV-like lesions in Harare. Biopsies were processed for histology and for human papillomavirus (HPV) typing. All patients had long-standing skin lesions that pre-dated the diagnosis of HIV by several years. The histology of skin biopsies from all patients was consistent with EV. In each biopsy, EV-associated β-HPV type 5 was identified (additionally, type 19 was found in 1 biopsy). Cutaneous wart-associated HPV types 1 and 2 were detected in all biopsies, together with genital lesion-associated HPV types 6, 16, and 52, (as well as ≥3 other genital lesion-associated HPV types). Despite immune reconstitution with combination antiretroviral therapy (cART), there was no improvement in EV-like lesions in any patient. EV is a disfiguring and potentially stigmatizing condition among this patient group and is difficult to treat; cART appears to have no impact on the progression of skin disease. Among adolescents with longstanding HIV-induced immunosuppression and with high levels of sun exposure, close dermatological surveillance for potential skin malignancy is required.

Year in review 2011: Respiratory infections, tuberculosis, pleural diseases, bronchoscopic intervention and imaging

This review highlights important contributions published in Respirology and other reputable respiratory journals in 2011 in four principle respiratory medicine areas, namely pulmonary infections, tuberculosis (TB), pleural diseases and chest imaging/interventional pulmonology. The articles have been selected for their insight, reliability and potential impact on clinical practice. From a total of 111 original articles and 40 review papers published in Respirology that year, 34% and 40%, respectively, were devoted to the earlier topics.