HIV-negative Females Research Articles

Poliovirus immunity among pregnant females aged 15-44 years, Namibia, 2010.

Poliovirus (PV) antibody seroprevalence studies assess population immunity, verify an immunization program's performance and vaccine efficacy, and guide polio eradication strategy. Namibia experienced a polio outbreak among adults in 2006, yet population seroimmunity was unknown. We tested 2061 specimens from Namibian pregnant females aged 15-44 years for neutralizing antibody to PV types 1-3 (PV1-3); all females were sampled during the 2010 National HIV Sentinel Survey. We determined the proportion of females seropositive for PV antibody by 5-year age strata, and analyzed factors associated with seropositivity, including age, gravidity, human immunodeficiency virus (HIV) infection status, residence, and antiretroviral treatment, by log-binomial regression. The seroprevalence was 94.6% for PV1, 97.0% for PV2, and 85.1% for PV3. HIV-positive females had significantly lower seroprevalence than HIV-negative females for PV1 (91.8% vs 95.3%; P<.01) and PV3 (80.0% vs 86.1%; P<.01) but not for PV2 (96.4% vs 97.1%; P=.3). The prevalence ratio of seropositivity for HIV-positive females versus HIV-negative females was 0.95 (95% confidence interval [CI], .92-.98) for PV1, 0.99 (95% CI, .97-1.01) for PV2, and 0.92 (95% CI, .87-.96) for PV3. Despite relatively high PV seroprevalence, Namibia might remain at risk for a PV outbreak, particularly in lower-seroprevalence populations, such as HIV-positive females. Namibia should continue to maintain high routine polio vaccination coverage.

Lack of an effect of rilpivirine on the pharmacokinetics of ethinylestradiol and norethindrone in healthy volunteers

Rilpivirine is a human immunodeficiency virus Type 1 (HIV-1) non-nucleoside reverse transcriptase inhibitor. Rilpivirine metabolism involves cytochrome P450 3A4 (CYP3A4). This trial (ClinicalTrials. gov number: NCT00739622) evaluated the interaction between rilpivirine and ethinylestradiol/norethindrone (combination oral contraceptives), which are metabolized by multiple pathways, including CYP3A4. During three consecutive 28-day cycles, 18 HIV-negative females received once-daily ethinylestradiol (35 μg)/norethindrone (1 mg) (Days 1 - 21); Days 22 - 28 were pill-free. Only in Cycle 3 was once-daily rilpivirine (25 mg) co-administered (Days 1 - 15). Minimum and maximum plasma concentrations (Cmin; Cmax) and area under the plasma concentration-time curve over 24 hours (AUC24h) of ethinylestradiol/norethindrone (Day 15, Cycles 2 and 3) and rilpivirine (Day 15, Cycle 3) were evaluated. Rilpivirine coadministration had no effect on (least square mean ratio, 90% confidence interval) ethinylestradiol Cmin (1.09, 1.03 - 1.16) or AUC24h (1.14, 1.10 - 1.19), but increased Cmax by 17% (1.17, 1.06 - 1.30), which is unlikely to affect ethinylestradiol pharmacodynamics. Norethindrone pharmacokinetics were unaffected by rilpivirine (AUC24h: 0.89, 0.84 - 0.94; Cmin: 0.99, 0.90 - 1.08; Cmax: 0.94, 0.83 - 1.06). Steady-state rilpivirine pharmacokinetics with ethinylestradiol/norethindrone was comparable with historical data for rilpivirine alone. Rilpivirine with ethinylestradiol/norethindrone was generally well tolerated. No new safety events were identified. Co-administration of rilpivirine, at the therapeutic dosing regimen, with ethinylestradiol/norethindrone does not affect hormone pharmacokinetics, and is, therefore, unlikely to affect the efficacy or safety of this oral hormonal contraceptive. Rilpivirine pharmacokinetics was not affected by ethinylestradiol/norethindrone. Rilpivirine (25 mg once daily) can be co-administered with ethinylestradiol/norethindrone-based contraceptives without dose modification.

HSV-2 Co-Infection as a Driver of HIV Transmission among Heterosexual Non-Injecting Drug Users in New York City

ObjectiveTo examine herpes simplex virus 2 (HSV-2)/HIV co-infection as a contributing factor in the increase in HIV infection among non-injecting heroin and cocaine users in New York City.MethodsSubjects were recruited from the Beth Israel Medical Center drug detoxification and methadone maintenance programs in New York City in 1995–1999 and 2005–2011. All reported current heroin and/or cocaine use and no injection drug use. A structured questionnaire was administered and serum samples collected for HIV and HSV-2 testing. Population-attributable risk percentages (PAR%s) were estimated for associations between HSV-2 and increased susceptibility to and increased transmissibility of HIV among female NIDUs.Results785 subjects were recruited from 1995–1999, and 1764 subjects from 2005–2011. HIV prevalence increased from 7% to 13%, with nearly uniform increases among all demographic subgroups. HSV-2/HIV co-infection was common in both time periods, with an average (over the two time periods) of 80% of HIV negative females infected with HSV-2, an average of 43% of HIV negative males infected with HSV-2; an average of 97% of HIV positive females also infected with HSV-2 and an average of 67% of HIV positive males also infected with HSV-2. The increase in HIV prevalence was predominantly an increase in HSV-2/HIV co-infection, with relatively little HIV mono-infection in either time period. The estimated PAR%s indicate that approximately half of HIV acquisition among females was caused by HSV-2 infection and approximately 60% of HIV transmission from females was due to HSV-2 co-infection.ConclusionsThe increase in HIV infection among these non-injecting drug users is better considered as an increase in HSV-2/HIV co-infection rather than simply an increase in HIV prevalence. Additional interventions (such as treatment as prevention and suppressing the effects of HSV-2 on HIV transmission) are needed to reduce further HIV transmission from HSV-2/HIV co-infected non-injecting drug users.

Sperm washing technique for safe conception in HIV sero-discordant couples

To assess the success of the sperm washing technique in HIV infected males in order to prevent HIV transmission but at the same time permit conception in the HIV negative female. There aren't any observational studies in the Middle East on this topic, hence the need for this study.

Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in Brazil

To investigate the prevalence of anal squamous intraepithelial lesions (ASIL) or anal cancer in patients attended at the Tropical Medicine Foundation of Amazonas. 344 patients consecutively attended at the institution, in 2007/2008, were distributed in the following strata according to presence/abscense of at risk conditions for anal cancer: Group 1 - HIV-positive men-who-have-sex-with-men (101); Group 2 - HIV-positive females (49); Group 3 - patients without any at risk condition for anal cancer (53); Group 4 - HIV-positive heterosexual men (38); Group 5 - HIV-negative patients, without anoreceptive sexual habits, but with other at risk conditions for anal cancer (45); Group 6 - HIV-negative men-who-have-sex-with-men (26); and Group 7 - HIV-negative anoreceptive females (32). The histopathological results of biopsies guided by high-resolution anoscopy were analyzed by frequentist and bayesian statistics in order to calculate the point-prevalence of ASIL/cancer and observe any eventual preponderance of one group over the other. The point-prevalence of ASIL for all the patients studied was 93/344 (27%), the difference between HIV-positive and negative patients being statistically significant (38.3% versus 13.5%; p < 0.0001). The prevalence of ASIL for each one of the groups studied was: Group 1 = 49.5%, Group 2 = 28.6%, Group 3 = 3.8%, Group 4 = 21.1%, Group 5 = 11.1%, Group 6 = 30.8% and Group 7 = 18.8%. Standard residual analysis demonstrated that ASIL was significantly prevalent in patients of Group 1 and high-grade ASIL in patients of Group 2. The odds for ASIL of Group 1 was significantly higher in comparison to Groups 2, 3, 4, 5 and 7 (p < 0.03). The odds for ASIL of Groups 2, 4 and 6 were significantly higher in comparison to Group 3 (p < 0.03). In the patients studied, ASIL (low and/or high-grade) tended to be significantly more prevalent in HIV-positive patients. Nonetheless, HIV-negative anoreceptive patients also presented great probability to have anal cancer precursor lesions, mainly those of the male gender.

Knowledge, Attitudes, and Behaviors Among a Sample of HIV-Positive and HIV-Negative Females Visiting an Urban VCT Center in Haiti

The knowledge, attitudes, and behaviors of over 43,000 women attending the Groupe Hatien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Centers in Haiti between 1999-2004 were examined. Comparative analyses were conducted for several sub-samples. Analyses revealed that across the entire sample, HIV-positive women appeared to engage in more risky behaviors than HIV-negative women (p< .01); however, as a group, pregnant HIV-positive women reported safer behaviors than non-pregnant HIV-positive women (p<.01). Women from all groups were generally knowledgeable about the risk of HIV transmission through dirty needles and mother to child. However, inaccurate information about transmission through supernatural means and mosquitoes was very common. These results suggest that knowledge and education are negatively associated with HIV status in this sample. Addressing gaps in knowledge and behavior and reducing the risky behaviors of HIV-positive individuals are important directions for future programs.

Effect of steady-state etravirine on the pharmacokinetics and pharmacodynamics of ethinylestradiol and norethindrone

Background Etravirine, a non-nucleoside reverse transcriptase inhibitor (NNRTI) active against NNRTI-resistant HIV, is an inducer of CYP3A4 and an inhibitor of CYP2C9/19. Study Design The effect of etravirine on the pharmacokinetics and pharmacodynamics of ethinylestradiol and norethindrone was assessed in 30 HIV-negative females. Following a run-in cycle with ethinylestradiol/norethindrone, the pharmacokinetics of ethinylestradiol and norethindrone was assessed on Day 15 of Cycle 2. Etravirine 200 mg bid was coadministered on Day 1 to Day 15 of Cycle 3, with pharmacokinetic assessments of ethinylestradiol, norethindrone and etravirine on Day 15. Results When combined with etravirine, the least-squares means (LSM) ratios (90% confidence interval) for ethinylestradiol AUC 24h, C max and C min were 1.22 (1.13–1.31), 1.33 (1.21–1.46) and 1.09 (1.01–1.18), respectively, compared to administration alone. LSM ratios for norethindrone parameters were 0.95 (0.90–0.99), 1.05 (0.98–1.12) and 0.78 (0.68–0.90), respectively. Conclusion These changes are not considered clinically relevant. No loss in contraceptive efficacy is expected when coadministered with etravirine.

HIV incidence in 3 years of follow-up of a Zimbabwe cohort—1998–2000 to 2001–03: contributions of proximate and underlying determinants to transmission

In recent years, HIV prevalence has begun to decline in Zimbabwe, which has been associated with reductions in sexual risk behaviour. Here, we analyse the determinants of HIV incidence in this period of decline and estimate the population-level impact of identified risk factors. A population-based cohort of 1672 HIV-negative adult males and 2465 HIV-negative adult females was recruited between 1998 and 2000. Each individual was then followed-up 3 years later. The influence and inter-relationship of social, behavioural and demographic variables were examined using a proximate determinants framework. To explore the population-level influence of a variable, methods were developed for estimating a risk factor's contribution to the reproductive number (CRN). HIV incidence was 19.9 [95% confidence interval (CI) 16.3-24.2] per 1000 person years in men and 15.7 (95% CI 13.0-18.9) in women. Multiple sexual partners, having an unwell partner, and reporting another sexually transmitted disease were risk factors that captured the main aspects of the proximate determinants framework: individual behaviour, partnership characteristics and the probability of transmission, respectively. If the proximate determinants fully captured risk of HIV infection, underlying factors would not influence a fully parameterized model. However, a number of underlying social and demographic determinants remained important in regression models after including the proximate determinants. For both sexes, having multiple sexual partners made a substantial CRN, but, for women, no behaviour explained more than 10% of new infections. The proximate determinants did not explain the majority of new infections at the population level. This may be because we have been unable to measure some risks, but identifying risk factors assumes that those acquiring infections are somehow different from others who do not acquire infections. That they are not suggests that in this generalized epidemic there is little difference in readily identifiable characteristics of the individual between those who acquire infection and those who do not.

Post transplantation human herpes virus-8 unrelated primary effusion lymphoma of the peritoneal cavity in a HIV-negative female

Primary effusion lymphoma (PEL) is a recently individualized form of non-Hodgkin lymphoma (WHO classification), developing mainly in HIV-infected males, more frequently homosexual, in advanced stages of the disease (total CD4+ lymphocyte count below 100-200/μl). Occasionally, it appears in other immunosupressive states (such as solid organs transplantation period) and even, although very rarely, in immunocompetent patients. From a pathogenic point of view, PEL has been related to Kaposi's sarcoma associated herpes virus (also named human herpesvirus 8, HHV 8) and to clinical antecedents of Kaposi's sarcoma. The relatively low frequency of this disease, the absence of a wide casuisticsts allowing a better characterization, and its unfavourable outcome, support the need of a deeper knowledge. We present here the clinico-biological findings of a HIV-negative patient, who was diagnosed of peritoneal PEL, of T cell origin, and not HHV 8-associated, five years after renal transplantation.

Peripheral blood mononuclear cell markers in antiretroviral therapy-naive HIV-infected and high risk seronegative adolescents. Adolescent Medicine HIV/AIDS Research Network.

To examine potential hematologic and immunologic markers for healthy adolescents and for adolescents infected with HIV. The REACH Project (Reaching for Excellence in Adolescent Care and Health) of the Adolescent Medicine HIV/AIDS Research Network (AMHARN) recruits HIV-infected and high-risk HIV-uninfected adolescents, aged at least 13 but less than 19 years. The study evaluates biomedical and behavioral features of HIV infection as observed while under medical care for HIV infection and adolescent health. Blood samples were collected from HIV-infected and HIV-uninfected subjects at 16 clinical sites. Cell phenotypes were determined using standard single, dual or three-color flow cytometry. This report includes data at enrollment for 94 HIV-positive adolescents who had never received antiretroviral therapy (ART) (mean age, 17.4 +/- 1.0 years for males and 16.5 +/- 1.3 years for females) and 149 HIV-negative adolescents (mean age, 16.7 +/- 1.2 years for males and 16.6 +/- 1.2 years for females); this is the antiretroviral therapy-naive subset drawn from 294 HIV-positive and 149 HIV-negative adolescents enrolled in the REACH Cohort. The total leukocyte count was significantly reduced in the HIV-positive females in comparison with the HIV-negative females (P < 0.001). There was a reduction in natural killer cells (P < 0.05) in HIV-positive females (mean, 140.6 +/- 104.2 x 10(6) cells/l) in comparison with HIV-negative females (184.3 +/- 142.5 x 10(6) cells/l), whereas no differences were found between the two groups of males. The reduction in the total CD4 cell count in HIV-positive males and females in comparison with the HIV-negative subjects was the consequence of a decrease in both the naive CD4 and memory CD4 components. There was a striking increase in the mean number of CD8 memory cells in HIV-positive compared with HIV-negative adolescents, and a corresponding increase in the percentage of these cells. In contrast, naive CD8 cells were present in increased numbers but their percentage was decreased. These studies of adolescents provide normative data for high-risk healthy adolescents as well as baseline immunologic data for a cohort of ART-naive HIV-positive adolescents. This comparison suggests that this untreated, recently infected group had relatively intact immunologic parameters.

Gender differences in HIV-related psychological distress in heterosexual couples.

In order to determine the effect of family support on the psychological well-being of heterosexual couples with at least one HIV-seropositive, family support data were obtained from couples, who were separately interviewed. Two hundred heterosexuals were interviewed (97 males, 103 females). 182 were partners in HIV serodiscordant couples (18 members were in 10 couples concordant for HIV-seropositivity). Overall, there were 76 HIV+ males and 30 HIV+ females. The Brief Symptom Inventory (BSI) was used to measure psychological distress. Sixty-five per cent of the subjects had family members aware of partners' HIV infection, but only 50% of aware families were reported as supportive. Family support was not a significant predictor of distress. Gender was the most significant predictor of psychological distress as measured by the BSI subscales. Both HIV positive and HIV negative females had more distress than their male counterparts on several dimensions (somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, phobic anxiety and paranoia), and on the General Severity Index (GSI) of the BSI (HIV-positives: p = 0.003; HIV-negatives: p = 0.01). Despite the general lack of association of family support with psychological distress, women in couples affected by HIV had more distress than men. The mental health needs of women clearly differ from men, and continued gender comparisons should be done to develop appropriate and effective interventions for these groups.

Antisperm Antibodies in Human Immunodeficiency Virus Infection: Effects on Fertilization and Embryonic Development1

Sera from human immunodeficiency virus (HIV)-infected males (n = 10) and females (n = 5) were analyzed for the presence of antisperm antibodies reacting against sperm-specific antigens. Of the HIV-positive males tested, sera of 40% were positive for human sperm extract (HSE), 70% for protamine, and 70% for fertilization antigen (FA-1) for at least one class of antibodies, compared to sera from HIV-negative males. Of the HIV-positive females tested, sera of 40% were positive for HSE, 30% for protamine, and 30% for FA-1 compared to sera from HIV-negative females. The majority of the sperm antigen-reactive antibodies belonged to the IgG class. The reactions observed with FA-1 were weaker than those with other antigens. Ninety percent of HIV-positive male sera and 80% of the HIV-negative female sera were found to contain immune complexes, 20% of which showed the presence of FA-1. HIV-positive male or female sera did not bind to any specific protein on the Western blot of HSE. The minimal amount of free anti-FA-1 antibodies present in sera did not bind to live sperm in the sperm immobilization technique, sperm agglutination technique, or immunobead binding technique and thus were incapable of affecting human sperm penetration of zona-free hamster ova (SPA). Nor did HIV-positive sera induce any apparent abnormality in the development of 2-cell embryos to blastocysts in vitro in murine bioassay. In conclusion, these results indicate that HIV-infected patients have sperm-specific antibodies in their sera that do not adversely affect SPA and murine embryo bioassay. There was a high incidence of immune complex formation after HIV infection. These data will provide the basis for exploring further the role of sperm antigens in altering the immunoregulatory mechanisms after HIV infection.