HIV-positive Research Articles

Impact of COVID-19 on Sexually Transmitted Infection and HIV Screening at an Urban Safety-Net Hospital

HIV and other sexually transmitted infections (STIs) are on the rise nationally and internationally. The coronavirus 2019 (COVID-19) pandemic drove a shift toward telemedicine and prioritization of symptomatic treatment over asymptomatic screening. The impact in safety-net settings, which faced disproportionate baseline STI/HIV rates rooted in structural inequities, and where many patients lack telemedicine resources, is not yet known. This study describes the impact of COVID-19 on STI/HIV testing at an urban safety-net hospital. We used descriptive statistics to compare hospital-wide chlamydia, gonorrhea, syphilis, and HIV testing volume and positivity rates in the following periods: prepandemic (July 1, 2019-February 29, 2020), peak-pandemic (March 1, 2020-May 31, 2020), and postpeak (June 1, 2020-August 31, 2021). STI and HIV test volume dropped sharply in March 2020. STI testing during the peak-pandemic period was 42% of prepandemic baseline (mean 1145 vs. 2738 tests/month) and nadired in April 2020 (766 tests/month). Similarly, peak-pandemic HIV testing was 43% of prepandemic baseline (mean 711 vs. 1635 tests/month) and nadired in April 2020 with 438 tests/month, concentrated in emergency department and inpatient settings. STI and HIV testing rates did not return to baseline for a full year. STI and HIV test positivity rates were higher in the peak-pandemic period compared with the prepandemic baseline. Given the precipitous decline in STI and HIV testing during the pandemic, safety-net settings should develop low-barrier alternatives to traditional office-based testing to mitigate testing gaps, high positivity rates, and associated morbidity.

Intersecting Sexual Behavior and Gender Identity Stigmas Among Transgender Women in the United States: Burden and Associations with Sexual Health.

In the United States, a context of multiple marginalization shapes sexual health disparities experienced by transgender women. Using data from 396 transgender women with negative or unknown HIV status, we performed exploratory factor analysis on responses to gender identity and sexual behavior stigma items and regressed sexual health outcomes on extracted factors via modified Poisson regression with robust variance estimation. Overall, 97.2% of participants endorsed ≥ 1 gender identity stigma; 67.2% endorsed ≥ 1 sexual behavior stigma; and 66.9% endorsed ≥ 1 of each. Extracted factors included gender-identity social stigma, reflecting experiences related to family, fearfulness in public, and verbal harassment (α = 0.68); gender-identity institutional stigma/violence, reflecting experiences related to healthcare, police interactions, and interpersonal violence (α = 0.73); and global sexual behavior stigma, reflecting experiences related to family, friends, and healthcare, as well as police interactions, fearfulness in public, verbal harassment,and interpersonal violence (α = 0.83). Gender-identity social stigma was significantly, positively associated with testing for HIV and testing for sexually transmitted infections. Gender-identity institutional stigma/violence and global sexual behavior stigma were both significantly, positively associated with condomless anal sex, sex work, testing for HIV, testing for sexually transmitted infections, and use of HIV pre-exposure prophylaxis. Stigma-mitigation remains critical to improve quality of life and sexual health for transgender women in the United States.

Prevalence of Mycoplasma genitalium infection with antimicrobial resistance mutations among gay sex workers in China.

Gay sex workers (GSWs) within the population of men who have sex with men in China are known as money boys (MBs). Limited research has been conducted to investigate the infection rate and antimicrobial resistance of Mycoplasma genitalium (M. genitalium) among GSWs in China. This study aimed to evaluate the status of M. genitalium infection among in GSWs. This study was performed among 349 GSWs who were followed up for four years by internet-based sampling collection. The participants were asked to complete an online questionnaire using a mobile app, and trained interviewers took urethral, anorectal, and saliva swab specimens. STIs, including HIV and M. genitalium, were detected. Detection of resistance-associated mutations (RAMs) to macrolides and fluoroquinolones was performed via Sanger sequencing of the 23S rRNA, parC and gyrA genes. GSWs were enrolled by identifying 10 initial "seeds" from the Blued and WeChat apps. Face-to-face interviews were conducted with 349 GSWs from June 2017 to July 2021. The prevalence of M. genitalium and HIV positivity was 92/349 (26.4%, 95% confidence interval [CI] 21.7-31.0) and 71/349 (20.3%, 95% CI 16.3-24.4), respectively. The proportion of GSWs with M. genitalium infection alone in urethral swabs was 16, and the proportion with symptoms was 2/16 (12.5%). The proportion of GSWs with M. genitalium infection alone in anorectal swabs was 36, and the proportion with symptoms was 3/36 (8.3%). Multivariate regression analysis showed that using new types of drugs in the past 3 months and inconsistent condom usage with clients in the past 30 days were associated with M. genitalium infection. Macrolide resistance within the 23S rRNA gene was detected in 73/88 (83.0%) of the M. genitalium-positive GSWs. Moreover, 79.8% (71/89) of parC and 21.1% (19/90) of gyrA genes had mutations responsible for fluoroquinolone resistance. Three cases had no mutations in any of the three genes, 11 cases had mutations in all three genes, five cases had gyrA and parC gene mutations with no mutation in the 23S rRNA gene, and 42 cases had 23S rRNA and parC gene mutations with no mutation in the gyrA gene. M. genitalium infections in our study displayed a high prevalence and very high levels of macrolide and fluoroquinolone resistance among GSWs in China. Asymptomatic M. genitalium infections are quite common among GSWs. Routine resistance testing of M. genitalium-positive specimens and antimicrobial resistance surveillance are crucial.

Cerebral Toxoplasmosis in an Immunocompetent Patient With Confirmed Covid-19 Positive

A case of a 30 years-old male patient, diagnosed with cerebral toxoplasmosis, confirmed HIV, with positive COVID-19. Once he came to the emergency department with a chief complaint of left upper and lower limbs weakness progressing for two days. The patient appeared malnourished and was afebrile and assessed to be well hydrated. He was alert but drowsy and had speech difficulty. A focused neurologic examination was performed and revealed a loss of nasolabial fold indicating facial nerve palsy. Neck stiffness was present and there was reduced motoric power in the left upper and lower limb of 2/5, with positive Babinski sign and Chaddock sign. According to brain CT, showed vasogenic cerebral edema and midline shift. Further laboratory exams showed positive IgG antibodies for Toxoplasma, with a titer exceeding 300 IU/ml, positive serum HIV, with CD4 cell count below 200cell/mm3. Complete blood count study highlighted low haemoglobin and elevated white cell count. He tested positive for COVID-19 by nasopharyngeal swab RT-PCR. Chest CT were done and revealed features of viral pneumonia with ground glass opacity appearance. In summary, we present a patient with cerebral involvement of toxoplasmosis possibly facilitated by pre-existing immunodeficiency as an opportunistic infections of HIV, and with COVID-19 complicated as acute infections. This case report reinforces a potential role for other comorbidities, rather than HIV infection as regards SARS-CoV-2 infection outcomes. For better assessment we need to do MRI.

Association between response to repeated negative HIV testing and risk sexual behaviors in men who have sex with men in Chengdu

Objective: To investigate the association between the response to repeated negative HIV testing and the risk sexual behaviors in men who have sex with men (MSM) in Chengdu. Methods: A total of 610 MSM were recruited by convenience sampling method through Chengdu Tongle Health Consultation Service Centre from March to May 2022. Data were collected from the MSM through questionnaire survey, including the demographic characteristics, sexual behaviors in the past 6 months, the response to rerpeated negative HIV testing. Univariate and multivariate logistic regression models were conducted to analyze the association between the response to repeated negative HIV testing and risk sexual behavior. Results: A total of 579 (94.9%) participants participated in the questionnaire survey and 354 (61.1%) subjects were included in the study.For the negative HIV testing, some MSM believed that they had taken effective protection measures (17.03±2.20), some believed that they were lucky (7.50±1.87) and some believed that they were at low risk (8.87±3.62). Multivariate logistic regression model showed that protected sexual behavior was negatively associated with group sex (aOR=0.80, 95%CI: 0.67-0.95), lucky was positively associated with casual sex (aOR=1.20, 95%CI: 1.06-1.35), inconsistent condom use (aOR=1.21, 95%CI: 1.06-1.37), group sex (aOR=1.26, 95%CI: 1.00-1.60), and multiple sexual partners (aOR=1.24, 95%CI: 1.09-1.42) and low risk perception was positively associated with multiple sexual partners only (aOR=1.08, 95%CI: 1.01-1.15). Conclusions: There were high levels of recognition of protected sexual behavior and lucky dimensions in response to repeated negative HIV testing and well risk perception in MSM in Chengdu. In HIV testing and counseling services, intervention and risk warning should be strengthened in MSM who believed that they are lucky to improve their awareness of safe sex and reduce the negative effects of fluke mind.

Improving provider-initiated testing for HIV and other STI in the primary care setting in Amsterdam, the Netherlands: Results from a multifaceted, educational intervention programme.

In the Netherlands, general practitioners (GPs) play a key role in HIV testing. However, the proportion of people diagnosed with late-stage HIV remains high, and opportunities for earlier diagnosis are being missed. We implemented an educational intervention to improve HIV and STI testing in primary care in Amsterdam, the Netherlands. GPs were invited to participate in an educational program between 2015 and 2020, which included repeat sessions using audit and feedback and quality improvement plans. Data on HIV, chlamydia and gonorrhoea testing by GPs were collected from 2011 through 2020. The primary outcome was HIV testing frequency, which was compared between GPs before and after participation using Poisson regression. Secondary outcomes were chlamydia and gonorrhoea testing frequencies, and positive test proportions. Additional analyses stratified by patient sex and age were done. GPs after participation performed 7% more HIV tests compared to GPs before participation (adjusted relative ratio [aRR] 1.07, 95%CI 1.04-1.09); there was no change in the proportion HIV positive tests (aRR 0.87, 95%CI 0.63-1.19). HIV testing increased most among patients who were female and ≤19 or 50-64 years old. After participation, HIV testing continued to increase (aRR 1.02 per quarter, 95%CI 1.01-1.02). Chlamydia testing by GPs after participation increased by 6% (aRR 1.06, 95%CI 1.05-1.08), while gonorrhoea testing decreased by 2% (aRR 0.98, 95%CI 0.97-0.99). We observed increases specifically in extragenital chlamydia and gonorrhoea testing. The intervention was associated with a modest increase in HIV testing among GPs after participation, while the proportion positive HIV tests remained stable. Our results suggest that the intervention yielded a sustained effect.

What motivated men to start PrEP? A cross-section of men starting PrEP in Buffalo city municipality, South Africa

BackgroundCompared to women, South African men are less likely to know their HIV status (78% vs. 89%), have suppressed viral loads (82% vs. 90%), or access HIV prevention services. To achieve epidemic control where heterosexual sexual behavior drives transmission, interventions to improve the uptake of HIV testing services (HTS) and prevention services must also target cis-gendered, heterosexual men. There is limited understanding of these men’s needs and wants with regards to accessing pre-exposure prophylaxis (PrEP).MethodsAdult men (≥ 18 years) from a peri-urban community in Buffalo City Municipality were offered community-based HTS. Those who received a negative HIV test result were offered community-based, same-day oral PrEP initiation. Men initiating PrEP were invited to participate in a study exploring men’s HIV prevention needs and reasons for initiating PrEP. An in-depth interview guide, developed using the Network-Individual-Resources model (NIRM), explored men’s perceived HIV acquisition risk, prevention needs, and preferences for PrEP initiation. Interviews were conducted by a trained interviewer in isiXhosa or English, audio-recorded and transcribed. Thematic analysis was used, guided by the NIRM to generate findings.ResultsTwenty-two men (age range 18–57 years) initiated PrEP and consented to study participation. Men reported elevated HIV acquisition risk associated with alcohol use and condom-less sex with multiple partners as facilitators driving PrEP initiation. They anticipated social support from family members, their main sexual partner and close friends for their PrEP use, and discussed other men as important sources of support for PrEP initiation. Nearly all men expressed positive views of people using PrEP. Participants believed HIV testing would be a barrier for men interested in accessing PrEP. Men recommended that access to PrEP be convenient, rapid, and community-based (i.e., not clinic-based).DiscussionSelf-perceived risk for HIV acquisition was a major facilitator for men’s PrEP initiation. Although men expressed positive perceptions of PrEP users, they noted that HIV testing may be a barrier to PrEP initiation. Finally, men recommended convenient access points to facilitate PrEP initiation and sustained use. Gender-responsive interventions tailored to men’s needs, wants, and voices will facilitate their uptake of HIV prevention services, and help to end the HIV epidemic.

HIV-1/2 prevalence among patients attending the Accident and Emergency Clinic in Southwest Nigeria.

The Human Immunodeficiency Virus (HIV) pandemic is without a doubt one of the most significant public health disasters of our day. It is a complex mashup of various epidemics that have spread inside and between different nations and areas of the world. Patients, who had retroviral screening in the Accident and Emergency Department of University College Hospital, Ibadan, were included in this retrospective analysis. In total, 2,321 patients were screened over the course of a year, and 83 (3.6%) of those had positive HIV-1/2 quick diagnostic test results using the Determine HIV-1/2, Uni-Gold HIV-1/2, and Stak-pak HIV-1/2 rapid diagnostic kits. A total of 1,248 (53.8%) males and 1,073 (46.2%) females were tested the positive values for men and women, respectively, were 42 (50.6%) and 41 (49.4%) (P = 0.921).

Characterization of Rare Spontaneous Human Immunodeficiency Virus Viral Controllers Attending a National United Kingdom Clinical Service Using a Combination of Serology and Molecular Diagnostic Assays.

We report outcomes and novel characterization of a unique cohort of 42 individuals with persistently indeterminate human immunodeficiency virus (HIV) status, the majority of whom are HIV viral controllers. Eligible individuals had indeterminate or positive HIV serology, but persistently undetectable HIV ribonucleic acid (RNA) by commercial assays and were not taking antiretroviral therapy (ART). Routine investigations included HIV Western blot, HIV viral load, qualitative HIV-1 deoxyribonucleic acid (DNA), coinfection screen, and T-cell quantification. Research assays included T-cell activation, ART measurement, single-copy assays detecting HIV-1 RNA and DNA, and plasma cytokine quantification. Human immunodeficiency virus seropositivity was defined as ≥3 bands on Western blot; molecular positivity was defined as detection of HIV RNA or DNA. Human immunodeficiency virus infection was excluded in 10 of 42 referrals, remained unconfirmed in 2 of 42, and was confirmed in 30 of 42, who were identified as HIV elite controllers (ECs), normal CD4 T-cell counts (median 820/mL, range 805-1336), and normal CD4/CD8 ratio (median 1.8, range 1.2-1.9). Elite controllers had a median duration of elite control of 6 years (interquartile range = 4-14). Antiretroviral therapy was undetected in all 23 subjects tested. Two distinct categories of ECs were identified: molecular positive (n = 20) and molecular negative (n = 10). Human immunodeficiency virus status was resolved for 95% of referrals with the majority diagnosed as EC. The clinical significance of the 2 molecular categories among ECs requires further investigation.

Engagement in HIV continuum of care: Another step needed to close the gap toward UNAIDS 90-90-90 targets among younger men in Rwanda.

In this study, we measured Rwandan men's engagement in HIV services based on the UNAIDS 90-90-90 targets and assessed factors associated with linkage to HIV services. We analyzed the Rwanda Population-based HIV Impact Assessment (RPHIA) data for 15- to 64-year-old males. We conducted bivariate analysis to assess the distribution and association of sociodemographic characteristics with UNAIDS 90-90-90 targets. We adjusted multivariable models to understand the effect measurement of associated factors and determine the factors that best predict the achievement of UNAIDS 90-90-90. Of 13 780 males aged 15-64 years who participated in the RPHIA and consented to the blood draw and HIV testing, 302 had a positive HIV result, while 301 had valid responses to all variables analyzed in this paper and were included in the analysis. We found that age group was an explanatory and predictive factor for achievement of UNAIDS 90-90-90. Younger men living with HIV (MLHIV) are less likely to have achieved UNAIDS 90-90-90 compared to MLHIV 50-64 years old: adjusted odds ratio (aOR) for MLHIV aged 15-34 years was 0.21 (0.08-0.53) and aOR for MLHIV aged 35-49 years was 0.77 (0.36-1.66). To close the UNAIDS 90-90-90 gap in Rwanda, innovative service delivery strategies are needed to support young MLHIV to reach 90-90-90.

Type-specific HPV incidence and clinical spectrum of lesions induced by high-risk oncogenic HPV types among study participants in Eastern Uganda

Different studies show that high-risk HPV genotypes are the main etiological agents for cervical cancer development and cancer-related deaths in women worldwide. In Uganda, cervical malignancies due to human papillomavirus (HPV) are predominant among sexually active women. However, data on the incidence and clinical spectrum of lesions associated with high-risk HPV infection is inadequate. The current study was aimed to determine incidence and clinical spectrum of lesions induced by high-risk oncogenic HPV types among study participants in Eastern Uganda. We piloted a prospective follow-up study among 1,077 women aged 15-55 years to assess the incidence and clinical spectrum of lesions associated with human papillomavirus infections (HPV). HPV Real-Time PCR using HPV High-Risk Screen Real-TM Quant 2x kit (Sacace, Biotechnologies, Italy) was used for genotyping high-risk HPV types. Four hundred and sixteen (416) of 1,077 (38.6%) women were monitored for an average time of 18 months (inter-quartile range 9.6-26.6). Forty-three (43) women had incident HPV infections during 214 person-years of follow-up reflecting an incidence rate of 20.1 per 100 person-years. Incident HPV infections were marginally associated with HIV positivity (RR = 3.0, 95% CI: 0.8 - 8.2) and usage of oral contraceptives (RR=2.6, 95% CI: 1.4 - 2.8) but not with the age of study subjects, or number sexual partners. Clearance for high-risk HPV infections was frequently ranging between 37.5% and 100.0% for high-risk types. Only 41.3% of women cleared all their infections. Clearance was associated with HIV negativity (Adjusted clearance = 0.3, 95% CI: 0.2 - 0.8) but not with age at study entry or oral contraceptive usage. Incident HPV infections and clearance of HPV type-specific infections were common among study participants. We also found a high prevalence of high-risk HPV types in cervical lesions, which reveals an association between cervical lesions and high-risk HPV types.

Maintaining HIV testing and treatment services in Zambia during COVID-19: a story of success and resilience

ABSTRACT Background Coronavirus disease 2019 (COVID-19) is caused by a virus called severe acute respiratory syndrome coronavirus. As countries struggled to control the spread of the virus through among other measures closure of health facilities, repurposing of health care workers, and restrictions on people’s movement, HIV service delivery was affected. Objectives To assess the impact of COVID-19 on HIV service delivery in Zambia by comparing uptake of HIV services before and during COVID-19. Methods We used repeated cross-sectional quarterly and monthly data on HIV testing, HIV positivity rate, people living with HIV initiating ART and use of essential hospital services from July 2018 to December 2020. We assessed quarterly trends and measured proportionate changes comparing periods before and during COVID-19 divided into three different comparison time frames: (1) annual comparison 2019 versus 2020; (2) April to December 2019 versus same period in 2020; and (3) Quarter 1 of 2020 as base period versus each of the other quarters of year 2020. Results Annual HIV testing dropped by 43.7% (95%CI 43.6–43.7) in 2020 compared to 2019 and was similar by sex. Overall, annual recorded number of newly diagnosed PLHIV fell by 26.5% (95% CI 26.37–26.73) in 2020 compared to 2019, but HIV positivity rate was higher in 2020, 6.44% (95%CI 6.41–6.47) compared to 4.94% (95% CI 4.92–4.96) in 2019. Annual ART initiation dropped by 19.9% (95%CI 19.7–20.0) in 2020 compared to 2019 while use of essential hospital services dropped during the early months of COVID-19 April to August 2020 but picked up later in the year. Conclusion While COVID-19 had a negative impact on health service delivery, its impact on HIV service delivery was not huge. HIV policies that were implemented before COVID-19 on testing made it easier to adopt COVID-19 control measures and to continue providing HIV testing services without much disruption.

Assessment of eligibility criteria in advanced urothelial cancer (aUC) trials based on ASCO-FCR recommendations.

453 Background: American Society of Clinical Oncology (ASCO) and the Friends of Cancer Research (FCR) underscored the need to broaden eligibility criteria in cancer trials to increase patient accrual, expand access to investigational treatments, and enhance generalizability of study results (Kim et al., Clin Cancer Res 2021). While eligibility criteria intend to prioritize patient safety and define a specific study population, these criteria are often based on outdated standards and may not be reflective of real-world practice. Our study aimed to characterize the proportion of aUC trial eligibility criteria according to the ASCO-FCR statement. Methods: Protocols indexed on ClinicalTrials.gov with start dates from June 30, 2012 to June 30, 2022 were evaluated. MeSH terms used in our query were “(metastatic OR advanced OR stage IV OR unresectable) AND (bladder cancer OR upper tract urothelial carcinoma OR upper tract urothelial cancer)”. International studies enrolling patients aged 18 and over in phases I-III were included. Studies examining multiple cancer types as well as those involving localized treatments (e.g., surgery or ablation), radiation therapy, and prognostic tools were excluded. Analyses of eligibility criteria focused on those highlighted in the ASCO-FCR statement; descriptive statistics were used to define the frequency of eligibility criteria and chi-square and Fisher’s exact test were used to determine their association with treatment type. Results: Overall, 205 urothelial cancer trials were assessed, with 37 (18.0%) having publicly accessible data. Of these, 13 (35.1%) evaluated combination therapy, 11 (29.7%) evaluated immunotherapy, 8 (21.6%) evaluated targeted therapy, and 5 (13.5%) evaluated chemotherapy. HIV positivity, HBV/HCV positivity, brain metastases, and concurrent malignancies were found to be exclusion criteria in 89.2% (33/37), 56.8% (21/37), 35.1% (13/37), and 5.4% (2/37) of studies, respectively. While brain metastases, concurrent malignancies, and HBV/HCV positivity were found to be independent of the class of therapy, a statistically significant association was observed with HIV positivity. Specifically, trials evaluating combination therapy (100.0%), immunotherapy (100.0%) and targeted therapy (87.5%) more frequently included HIV positivity as an exclusion criterion as compared to chemotherapy trials (40.0%). Conclusions: A modest percentage of a UC studies from the last decade were observed to report overly restrictive eligibility criteria as defined by the ASCO-FCR statement. HIV positivity and HBV/HCV positivity were commonly identified exclusion criteria, despite limited evidence that these criteria significantly impact drug efficacy and tolerability. Reassessing and updating eligibility criteria will ensure that the resulting data is more reflective and inclusive of a real-world population.

Evaluation of eligibility criteria in advanced prostate cancer clinical trials based on ASCO-FCR recommendations.

34 Background: The American Society of Clinical Oncology (ASCO) and the Friends of Cancer Research (FCR) published a joint statement addressing clinical eligibility for characteristics lacking adequate representation in recent studies (Kim et al., Clin Cancer Res 2021). Herein, we aimed to identify the frequency of other potentially excessive exclusion criteria in the context of metastatic prostate cancer. Methods: The eligibility criteria of advanced prostate cancer studies with start dates between June 30, 2012 and June 30, 2022 were identified through Clinicaltrials.gov. MeSH (Medical Subject Headings) terms in our query were “(metastatic OR advanced OR stage IV OR unresectable) AND (prostate cancer OR prostate adenocarcinoma)”. Our study included trials conducted worldwide and examined patients aged 18 and over in phase I-III trials. To narrow the scope of study, trials including more than one cancer type (basket trials) as well as those focusing on radiation therapy were not included in the study. Descriptive statistics were used to determine the frequency of eligibility criteria while the Fisher’s exact test or chi-square test were performed to demonstrate association between type of treatment and exclusion criteria. Results: 265 of 699 (37.9%) clinical trials within the specified search had sufficiently available data for evaluation. Of these, 136 (51.3%), 51 (19.2%), 26 (9.8%), 20 (7.5%), 19 (7.2%), and 7 (2.6%) of trials investigated treatment with combination therapy, hormone therapy, targeted therapy, immunotherapy, radioligand therapy, and chemotherapy, respectively. The most common ASCO-FCR-cited exclusion criteria in the studies were brain metastases (161/265, 60.8 %), HIV positivity (123/265, 46.4%), HBV/HCV positivity (122/265, 46.0%), and concurrent malignancies (41/265, 16.6%). Statistically significant relationships were identified between type of treatment along with status of brain metastases, HIV, and HBV/HCV (p=0.011, <0.001, and 0.001, respectively. Conclusions: This study represents the first effort to analyze this specific subset of exclusion criteria in relation to type of treatment in advanced prostate cancer. Attention to the ASCO-FCR consensus statement may maximize patient representation in future studies and increase generalizability of data. [Table: see text]

Surgical management of appendicitis in patients with human immunodeficiency virus (HIV) positivity: a propensity score-matched analysis in a base hospital for HIV treatment in Japan.

To investigate the impact of human immunodeficiency virus (HIV) infection on surgical outcomes after appendectomy. Data on patients who underwent appendectomy for acute appendicitis between 2010 and 2020 at our hospital were investigated retrospectively. The patients were classified into HIV-positive and HIV-negative groups using propensity score-matching (PSM) analysis, adjusting for the five reported risk factors for postoperative complications: age, sex, Blumberg's sign, C-reactive protein level, and white blood cell count. We compared the postoperative outcomes of the two groups. HIV infection parameters, including the number and proportion of CD4 + lymphocytes and the HIV-RNA levels were also compared before and after appendectomy in the HIV-positive patients. Among 636 patients enrolled, 42 were HIV-positive and 594 were HIV-negative. Postoperative complications occurred in five HIV-positive patients and eight HIV-negative patients, with no significant difference in the incidence (p = 0.405) or severity of any complication (p = 0.655) between the groups. HIV infection was well-controlled preoperatively using antiretroviral therapy (83.3%). There was no deterioration in parameters and no changes in the postoperative treatment in any of the HIV-positive patients. Advances in antiviral drugs have made appendectomy a safe and feasible procedure for HIV-positive patients, with similar postoperative complication risks to HIV-negative patients.

Evaluation of eligibility criteria in contemporary renal cell carcinoma based on ASCO-FCR recommendations.

612 Background: A consensus statement from the American Society of Clinical Oncology (ASCO) and Friends of Cancer Research (FCR) collaboration highlights the importance of expanding eligibility criteria in cancer trials to more accurately reflect the real-world population (Kim et al., Clin Cancer Res 2021). We sought to characterize use of overly restrictive eligibility criteria in renal cell carcinoma (RCC) trials in the context of ASCO-FCR recommendations. Methods: Studies containing the MeSH terms “(metastatic OR advanced OR stage IV or unresectable) AND (kidney cancer OR renal cell carcinoma OR renal cell cancer)” from June 30, 2012 to June 30, 2022 were identified on the ClinicalTrials.gov platform. Our search query’s inclusion criteria identified international studies examining adult patients aged ≥ 18 in phase I-III trials. Exclusion criteria comprised pan-cancer studies, trials involving localized treatments, radiation therapy, and prognostic tools. Descriptive statistics were used to characterize the frequency of restrictive eligibility criteria across studies, while Fisher’s exact test or chi-square test were utilized to determine the association between treatment type and exclusion criteria. Results: The content of 423 RCC trials were analyzed, of which 112 (26.5%) had adequate data available. 48 (42.9%), 44 (39.3%) and 18 (16.1%) studies examined combination therapy, targeted therapy, and immunotherapy, respectively. The presence of HIV positivity, HBV/HCV positivity, brain metastases, and concurrent malignancies accounted for the most frequently cited exclusionary criteria, seen in 83/112 (74.1%), 60/112 (53.6%), 37/112 (33.0%), and 9/112 (8.0%) studies respectively. Differences in the use of HIV positivity (p<0.001) and HBV/HCV positivity (p<0.001) as eligibility criteria were observed across classes of therapy (see Table). Conclusions: A significant proportion of RCC studies utilize overly restrictive eligibility criteria as highlighted by the ASCO-FCR joint statement. Appropriate broadening of eligibility criteria to incorporate patient populations mirroring a real-world setting will provide more useful data going forward. [Table: see text]

Barriers and facilitators to oral PrEP uptake among high-risk men after HIV testing at workplaces in Uganda: a qualitative study

BackgroundMen in Uganda contribute significantly to new HIV infections annually yet PrEP uptake among them is low and those initiated are likely to discontinue usage. We explored the barriers and facilitators to PrEP uptake among high-risk men employed in private security services with negative HIV results after testing at workplaces in Uganda.MethodsAn explorative qualitative study comprising in-depth participant interviews. Data were collected via telephone calls and manually analyzed by inductive content analysis.ResultsFifty-six (56) men participated, 27(48.21%) had heard about PrEP, and 29(51.79%) were willing to initiate it. Four categories emerged for the facilitators of PrEP uptake including the perceived need for HIV prevention, awareness creation, availability, and sexual freedom. Six categories emerged for the barriers to PrEP uptake. These were: Inaccessibility of PrEP services, Misinformation, Knowledge deficit, Medication-related barriers, Potential for increased risky sexual behavior, and Perceptions about PrEP use.ConclusionThe findings suggest the need for healthcare providers to offer information regarding PrEP and HIV prevention services and mass sensitization campaigns to facilitate uptake. Participants recommend mass roll-out of PrEP to lower-level facilities and accessible pick-up points for men such as workplaces. The men also suggested the use of longer-acting PrEP modalities such as an injectable option or an option that is utilized specifically by the female partner. Finally, the stigma surrounding PrEP use could be reduced by the separation of PrEP and ART services at health facilities, or special pick-up days to reduce waiting times.

A Case Report: False-Negative HIV Antibody Test in a Patient Presenting With an Unusual Case of Cytomegalovirus Oropharyngeal Ulcerations

Abstract Background Cytomegalovirus (CMV) oropharyngeal ulcerations are rare diagnoses that usually only occur in immunocompromised individuals. False-negative third-generation HIV tests in a patient with AIDS are also exceedingly rare and, when they occur, underscore the complex host and viral relationships involved in HIV disease mediation. Case Presentation We present a case of CMV oropharyngeal ulcerations in a patient diagnosed with advanced AIDS with a persistently negative HIV antibody test. Confirmative testing and diagnosis of HIV were performed with a qualitative DNA polymerase chain reaction and confirmed with a quantitative RNA polymerase chain reaction. Cytomegalovirus oropharyngeal ulcerations were managed with ganciclovir 5 mg/kg with significant improvement in oral ulcers. Conclusions We present a rare case of an HIV-seronegative patient clinically diagnosed with advanced AIDS and CMV oropharyngeal ulcerations. False-negative HIV tests can delay diagnosis and treatment; hence, clinical suspicion is needed for accurate diagnosis and early treatment.

Use of Mobile Health on Adherence among HIV Positives Person: A Literature Review

Aim: Antiretroviral is the main key to improving the quality of life and among ways to prevent the transmission of diseases due to HIV. In the use of drugs in the long term, psychosocial problems that arise often become barriers to patient adherence. This paper aims to show various forms of application and see the benefits derived from the use of mobile health (m-Health) in increasing the adherence of HIV positive patients. Method: The method used is a review of journals from Pubmed published no more than the last five years about the use of mobile health in those infected with HIV. Result: The result is that all existing articles provide explanations about the application of mobile health and positive result in supporting adherence, but there is a note regarding the consideration of its implementation goals and the services provided as well as the retention rate after using after several time. Conclusion: The conclusion is that mobile health provides benefits to increase adherence and help overcome the patient’s psychosocial problems.

459 - Breaking Down Barriers: Analysing the Impact of Age, Race, HIV Positivity and Socioeconomic Status on Access to Autologous Stem Cell Transplant for Primary CNS Lymphoma in a Minority Rich, Underprivileged Inner-City Cohort

459 - Breaking Down Barriers: Analysing the Impact of Age, Race, HIV Positivity and Socioeconomic Status on Access to Autologous Stem Cell Transplant for Primary CNS Lymphoma in a Minority Rich, Underprivileged Inner-City Cohort