HIV-positive Cases Research Articles

KNOWLEDGE OF HIV/AIDS AND COVID-19 PANDEMIC AMONG DENTAL UNDERGRADUATE STUDENTS

Background: Within a century, COVID-19 is the 9th pandemic to worst hit the entire globe. The dental professionals are directly involved while treating patients in an aerosolized atmosphere. Aim: To assess the knowledge of HIV/AIDS and COVID-19 pandemic among dental undergraduate students Materials and Methods: A cross-sectional survey was conducted using a web-based survey instrument (google forms). A total of 366 dental undergraduate students of TMDCH, Chennai participated in the survey. Data obtained was analyzed using SPPS IBM Software. Results: The knowledge on COVID-19 was better than HIV/AIDS, among the dental undergraduate students. Only 25.7% of the respondents had a previous experience of handling HIV positive case and just more than half (56.3%) of the students were willing to treat HIV patient. Mere 25.7% agreed that HIV is a pandemic. For the COVID-19, only 45.6% of the students were confident to treat a positive/suspected patient and just 17.2% knew the types of corona virus. Knowledge on other questions asked was adequate. Dilemma prevailed if COVID-19 could cause diabetes and was air-borne. Conclusion: There has to be an immediate intervention of the dental institutions to raise awareness on pandemics and their protocols while treatment of the patient among dental students through continuing education programs.

HIV Pozitif Olgularda Viral Hepatit ve Sifiliz Koinfeksiyonu Seroprevalansının İrdelenmesi

HIV Pozitif Olgularda Viral Hepatit ve Sifiliz Koinfeksiyonu Seroprevalansının İrdelenmesi

Cost-effectiveness of facility-based, stand-alone and mobile-based voluntary counseling and testing for HIV in Addis Ababa, Ethiopia

BackgroundGlobally, there is a consensus to end the HIV/AIDS epidemic by 2030, and one of the strategies to achieve this target is that 90% of people living with HIV should know their HIV status. Even if there is strong evidence of clients’ preference for testing in the community, HIV voluntary counseling and testing (VCT) continue to be undertaken predominantly in health facilities. Hence, empirical cost-effectiveness evidence about different HIV counseling and testing models is essential to inform whether such community-based testing are justifiable compared with additional resources required. Therefore, the purpose of this study was to compare the cost-effectiveness of facility-based, stand-alone and mobile-based HIV voluntary counseling and testing methods in Addis Ababa, Ethiopia.MethodsAnnual economic costs of counseling and testing methods were collected from the providers’ perspective from July 2016 to June 2017. Ingredients based bottom-up costing approach was applied. The effectiveness of the interventions was measured in terms of the number of HIV seropositive clients identified. Decision tree modeling was built using TreeAge Pro 2018 software, and one-way and probabilistic sensitivity analyses were conducted by varying HIV positivity rate, costs, and probabilities.ResultsThe cost of test per client for facility-based, stand-alone and mobile-based VCT was $5.06, $6.55 and $3.35, respectively. The unit costs of test per HIV seropositive client for the corresponding models were $158.82, $150.97 and $135.82, respectively. Of the three models, stand-alone-based VCT was extendedly dominated. Mobile-based VCT costs, an additional cost of USD 239 for every HIV positive client identified when compared to facility-based VCT.ConclusionUsing a mobile-based VCT approach costs less than both the facility-based and stand-alone approaches, in terms of both unit cost per tested individual and unit cost per HIV seropositive cases identified. The stand-alone VCT approach was not cost-effective compared to facility-based and mobile-based VCT. The incremental cost-effectiveness ratio for mobile-based VCT compared with facility-based VCT was USD 239 per HIV positive case.

Outcome of HIV Testing Among Family Members of Index Cases Across 36 Facilities in Abidjan, Côte d'Ivoire.

In Côte d'Ivoire, the Family Approach to Counseling and Testing (FACT) program began in 2015 and provides facility-based HIV testing to the sexual partners, children and other household family members of HIV-positive index cases. We evaluated whether the FACT program is an effective approach to HIV case finding. We reviewed 1762 index patient charts to evaluate outcomes of the FACT program, held across 36 facilities in Abidjan. Index cases enumerated a total of 644 partners, 2301 children and 508 other family members including parents and siblings. Among the partners tested for HIV, the positivity rate was 21%; for children the positivity rate was 5% and for all other family members the positivity rate was 11%. Offering HIV testing services to the family members of HIV positive index cases is an effective approach to case finding in Côte d'Ivoire. Particularly, offering HIV testing to the partners of positive women index cases can be key to identifying previously undiagnosed men and linking them to treatment.

Global Disease Outbreaks and Effects on Maternal, Newborn & Child Health in Global South, a Systematic Review

Background/Aim: The world has witnessed several disease outbreaks both in the past and in recent times. Apart from loss of lives as a result of such outbreaks, there are also disruptions in health care provision and utilization due to certain measures aimed at curtailing the spread of such outbreaks. This study aimed to seek evidence from existing literature on the effects of disease outbreaks on maternal, newborn and child health care in Global South.
 Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used and 14 literatures met the inclusion criteria.
 Results: HIV/AIDS pandemic affected the Maternal Newborn and Child Health since increased cases of anaemia, hospital admissions, still births in HIV positive pregnant and cases of foetal anaemia reported in infants born from HIV positive pregnant women were reported. No COVID-19 pandemic related-effects on MNCH observed since no maternal deaths and transmission from infected pregnant women to their newborns reported. Indirect effects of pandemics on MNHC include reduced service delivery and demand/utilization as well as inaccessibility due to diverse reasons.
 Discussion: The Government should put in place palliative measures for low-income citizens; engage and sensitize women, pregnant women and their children on available health care services and mitigation measures in place to access with minimal or no risk of being infected in a secure environment.

Assessing the costs and efficiency of HIV testing and treatment services in rural Malawi: implications for future \u201ctest and start\u201d strategies

BackgroundReaching the 90–90-90 targets requires efficient resource use to deliver HIV testing and treatment services. We investigated the costs and efficiency of HIV services in relation to HIV testing yield in rural Karonga District, Malawi.MethodsCosts of HIV services were measured over 12 months to September 2017 in five health facilities, drawing on recognised health costing principles. Financial and economic costs were collected in Malawi Kwacha and United States Dollars (US$). Costs were calculated using a provider perspective to estimate average annual costs (2017 US$) per HIV testing episode, per HIV-positive case diagnosed, and per patient-year on antiretroviral therapy (ART), by facility. Costs were assessed in relation to scale of operation and facility-level annual HIV positivity rate. A one-way sensitivity analysis was undertaken to understand how staffing levels and the HIV positivity rate affected HIV testing costs.ResultsHIV testing episodes per day and per full-time equivalent HIV health worker averaged 3.3 (range 2.0 to 5.7). The HIV positivity rate averaged 2.4% (range 1.9 to 3.7%). The average cost per testing episode was US$2.85 (range US$1.95 to US$8.55), and the average cost per HIV diagnosis was US$116.35 (range US$77.42 to US$234.11), with the highest costs found in facilities with the lowest daily number of tests and lowest HIV yield respectively. The mean facility-level cost per patient-year on ART was approximately US$100 (range US$90.67 to US$115.42). ART drugs were the largest cost component averaging 71% (range 55 to 76%). The cost per patient-year of viral load tests averaged US$4.50 (range US$0.52 to US$7.00) with cost variation reflecting differences in the tests to ART patient ratio across facilities.ConclusionGreater efficiencies in HIV service delivery are possible in Karonga through increasing daily testing episodes among existing health workers or allocating health workers to tasks in addition to testing. Costs per diagnosis will increase as yields decline, and therefore, encouraging targeted testing strategies that increase yield will be more efficient. Given the contribution of drug costs to per patient-year treatment costs, it is critical to preserve the life-span of first-line ART regimens, underlining the need for continuing adherence support and regular viral load monitoring.

Using HIV self-testing to increase the affordability of community-based HIV testing services.

Objectives:This study estimates the costs of community-based HIV testing services (HTS) in Lesotho and assesses the potential efficiency gains achieved by adding HIV self-testing (HIVST) and then self-testing booths.Design:Micro-costing analysis using longitudinal data from a real-world intervention.Methods:We collected data prospectively on provider's costs and programmatic outcomes over three time periods of approximately 8 months each, between May 2017 and April 2019. The scope of services was extended during each period as follows: HTS only, HTS and HIVST, HTS and HIVST with individual HIVST booths wherein clients were encouraged to self-test on-site followed by on-site confirmative testing for those with reactive self-test. For each implementation period, we estimated the full financial and economic implementation costs, the incremental costs of adding HIVST onto conventional HTS and the cost per HIV positive case identified.Results:Costs per HIV-positive case identified increased between period 1 (US$956) and period 2 (US$1249) then dropped in period 3 (US$813). Full versus incremental cost analyses resulted in large differences in the magnitude of costs, attributable to methods rather than resource use: for example, in period 3, the average full and incremental cost estimates for HTS were US$34.3 and US$23.5 per person tested, and for HIVST were US$37.7 and US$14.0 per kit provided, respectively.Conclusion:In Lesotho, adding HIVST to community-based HTS improves its overall affordability for HIV-positive case finding. The reporting of both full and incremental cost estimates increase transparency for use in priority setting, budgeting and financial planning for scale-up.

Transmission Dynamics in Tuberculosis Patients With Human Immunodeficiency Virus: A Systematic Review and Meta-analysis of 32 Observational Studies.

There are large knowledge gaps on the transmission dynamics of Mycobacterium tuberculosis in settings where both tuberculosis and human immunodeficiency virus (HIV) are endemic. We aimed to assess the infectiousness of tuberculosis patients coinfected with HIV. We systematically searched for studies of contacts of both HIV-positive and HIV-negative tuberculosis index cases. Our primary outcome was Mycobacterium tuberculosis infection in contacts. Data on sputum smear and lung cavitation status of index cases were extracted from each study to assess effect modification. Secondary outcomes included prevalent tuberculosis and HIV in contacts of HIV-positive and HIV-negative index cases. Of 5255 original citations identified, 32 studies met inclusion criteria, including 25 studies investigating M. tuberculosis infection (Nparticipants = 36 893), 13 on tuberculosis (Nparticipants = 18 853), and 12 on HIV positivity (Nparticipants = 18 424). Risk of M. tuberculosis infection was lower in contacts of HIV-positive index cases (odds ratio [OR], 0.67, 95% confidence interval [CI], .58-.77) but was heterogeneous (I2 = 75.1%). Two factors modified this relationship: the lung cavitary status of the index case and immunosuppression (measured through CD4 counts or HIV or acquired immunodeficiency syndrome diagnoses) among index people living with HIV. Rates of HIV were consistently higher in contacts of coinfected index cases (OR, 4.9; 95% CI, 3.0-8.0). This was modified by whether the study was in sub-Saharan Africa (OR, 2.8; 95% CI, 1.6-4.9) or in another global region (OR, 9.8; 95% CI, 5.9-16.3). Tuberculosis patients coinfected with HIV are less infectious than HIV-uninfected cases when they have severe immunosuppression or paucibacillary disease. Contacts of coinfected index cases are almost 5 times more likely to also have HIV.

Ending the HIV Epidemic: Contributions Resulting From Syphilis Partner Services.

There is a high level of coinfection with human immunodeficiency virus (HIV) among persons diagnosed with syphilis in the United States. Public health workers at state and local health departments help inform exposed partners to sexually transmitted disease (STD)/HIV infections to facilitate early testing and treatment (partner services). The federal initiative, Ending the HIV Epidemic (EHE), identifies 4 key strategies: diagnose, treat, prevent, and respond. This study describes the contributions of syphilis partner services to the EHE strategies in a county prioritized by the EHE plan. A retrospective record review of reported early syphilis cases (less than 1 year's duration) between 2016 and 2018 in the Indianapolis area was conducted to determine the extent of new HIV diagnoses, retention in HIV care, and other evidence-based HIV prevention interventions occurring after provision of syphilis partner services. A total of 752 partners to early syphilis were attempted to be notified of exposure. There were 1,457 case patients and partners that received STD/HIV prevention counseling; 400 partners received STD treatment, 352 partners learned their HIV status, and 22 received new HIV diagnoses, with 68% retained in medical care and 60% virally suppressed. Two thirds of partner services were completed within 21 days. New HIV positivity among partners to HIV-negative syphilis case patients was 3.5% and 14% among HIV-positive syphilis case patients. Partner services for syphilis was an effective method of addressing the EHE strategies, resulting in persons at risk tested, STD treatment provided, behavioral prevention counseling provided, and new HIV cases identified, leading to retention in medical care and viral suppression.

Representation of People with HIV/AIDS in The Jakarta Post and Jakarta Globe: A Critical Discourse Analysis

This study aims to understand representational meanings from the transitivity choices used by news reports from The Jakarta Post and Jakarta Globe in reporting people with HIV-positive cases and exposing the underlying ideology behind the representation. Fairclough’s three-dimensional concept in Critical Discourse Analysis (CDA) was applied in this study. The study also relied on Halliday’s systemic functional grammar, particularly in the transitivity analysis. Two selected articles were collected from The Jakarta Post and Jakarta Globe newspapers. The findings revealed that both news media dominantly report people with HIV/AIDS through material process, then followed by verbal process and relational process. Next, the study found that people with HIV/AIDS are represented as discriminated and threatened group in The Jakarta Post; meanwhile, they are represented as a mistreated group in Jakarta Globe. Last, the study found that The Jakarta Post attempts to construct that people with HIV/AIDS need to be more accepted and protected; meanwhile, Jakarta Globe attempts to construct an idea that people with HIV/AIDS need to be given more attention. To sum up, the combination of the both theories is substantially advantageous in the discourse to expose ideology.

Cost variations in prevention of mother-to-child HIV transmission services integrated within maternal and child health services in rural Tanzania

ABSTRACT We estimated the costs of Option B+ for HIV-infected pregnant women in 12 facilities in Morogoro Region, Tanzania, from a provider perspective. Costs of prevention of mother-to-child (PMTCT) HIV services were measured over 12 months to September 2017 to estimate the average costs per HIV testing episode, per HIV-positive case diagnosed, per patient-year on antiretroviral therapy (ART), and per neonatal HIV care. A one-way sensitivity analysis was undertaken to understand how staffing levels and other core resource inputs affected costs. The total number of HIV testing episodes was 25,593 with 279 HIV cases identified yielding a 1.1% positivity rate. The average cost per testing episode was US$5.49 (range US$2.13 to US$13.93), and the average cost per HIV case detected was US$503.29 (range US$230.61 to US$3330.38). The number of pregnant women initiated on ART was 278. The mean cost per patient-year on ART was US$159.89 (range US$100.91 to US$812.23). The average cost of neonatal HIV care was US$90.09 (range US$41.53 to US$180.26). PMTCT service costs varied widely across facilities due to variations in resource use, number of women testing, and HIV prevalence. The study provides further evidence against generalising cost estimates, and that budgeting and planning requires context specific cost information.

Mitochondrial DNA Damage and Brain Aging in Human Immunodeficiency Virus.

BackgroundNeurocognitive impairment (NCI) remains common in people living with human immunodeficiency virus (PLWH), despite suppressive antiretroviral therapy (ART), but the reasons remain incompletely understood. Mitochondrial dysfunction is a hallmark of aging and of neurodegenerative diseases. We hypothesized that human immunodeficiency virus (HIV) or ART may lead to mitochondrial abnormalities in the brain, thus contributing to NCI.MethodsWe studied postmortem frozen brain samples from 52 PLWH and 40 HIV-negative controls. Cellular mitochondrial DNA (mtDNA) content and levels of large-scale mtDNA deletions were measured by real-time polymerase chain reaction. Heteroplasmic mtDNA point mutations were quantified by deep sequencing (Illumina). Neurocognitive data were taken within 48 months antemortem.ResultsWe observed a decrease in mtDNA content, an increase in the mtDNA “common deletion,” and an increase in mtDNA point mutations with age (all P < .05). Each of these changes was exacerbated in HIV-positive cases compared with HIV-negative controls (all P < .05). ART exposures, including nucleoside analogue reverse transcriptase inhibitors, were not associated with changes in mtDNA. The number of mtDNA point mutations was associated with low CD4/CD8 ratio (P = .04) and with NCI (global T-score, P = .007).ConclusionsIn people with predominantly advanced HIV infection, there is exacerbation of age-associated mtDNA damage. This change is driven by HIV per se rather than by ART toxicity and may contribute to NCI. These data suggest that mitochondrial dysfunction may be a mediator of adverse aging phenotypes in PLWH.

Neurological Manifestations among Patients with HIV – Active Tuberculosis co Infection

At least one-third of the 35.3 million people living with HIV worldwide are infected with latent tuberculosis. Tuberculosis is the most common presenting illness among people living with HIV, including those who are taking antiretroviral treatment. There were an estimated 1.1 million HIV positive new TB cases globally in 2012. Around 75% of these people live in sub-Saharan Africa. Despite its great burden, neurological manifestations have not been described yet in patients with HIV-active tuberculosis, although tuberculosis and HIV have synergistic influence on immunity system which may contribute to change in prevalence or severity of CNS involvement in patients with HIV-active TB co infection. Objectives: To study neurological manifestations in patients with HIV-active tuberculosis.

Seroprevalence of anti-hepatitis E antibodies and antigens among HIV-infected patients in Fars Province, southern Iran

ObjectiveHIV-infected patients have immunological and clinical features that might affect the pathogenesis, as well as the outcome of the HIV/HEV co-infection. The current study aimed to determine the seroprevalence of anti-HEV antibodies and HEV antigens among HIV-infected patients in Fars Province, Southwest Iran.MethodsBlood samples (5 mL) were collected from 251 HIV-confirmed patients. Respective data, including patients’ demographic information, were obtained for each patient. The presence of HEV antigens and anti-HEV antibodies (IgG) were assessed by commercial ELISA kits, based on the manufacturers’ instructions.ResultsOut of 251 cases, 158 (62.9%) were male and 91 (36.3%) were female. Patients’ age varied from 14 to 83 (mean: 40 ± 9.7) years. Out of 251 HIV positive cases, 26 (10.4%) were positive for anti-HEV IgG antibodies and 6 (2.4%) were positive for HEV-antigens. Also, 2 (0.8%) of the patients were positive for both anti-HEV IgG antibodies and antigens. Statistical analysis revealed no significant association between sex and seropositivity to either HEV antigen or antibodies. Moreover, no significant association was seen between age and seropositivity to HEV antigen or antibody (P = 0.622 and 0.945, respectively).ConclusionOur results showed a relatively low prevalence of HEV-antibodies in HIV-infected patients, indicating that HIV positive patients may not be at greater risk of HEV infection than the general population. Moreover, HEV-antigen was detected in a few cases of HIV-infected individuals which indicate an acute or chronic HEV infection in these patients.

The Pattern and Outcome of Management of Acquired Anorectal fistulas in Children at a semi-urban Teaching Hospital

Background: Acquired anorectal fistulas are a severe cause for parental concerns, and they pose considerable challenges in their management.&#x0D; Aim: The aim of this study is to document the pattern of presentation and the management outcome for the cases of acquired anorectal fistula in children seen in our centre.&#x0D; Method: A retrospective review of the thirteen (13) case notes of the patients with acquired anorectal fistulas managed from 2008-2011 was done. The information retrieved included; the age at presentation, sex, aetiology of the fistula, site of the fistula, the duration of the fistula to the presentation, weight loss, and other associated medical conditions, history of a developmental milestone,type of intervention, the outcome of management, HIVstatus of patients and parents.&#x0D; Results: There were two males and eleven females; eight of whom were HIV positive. Five fistulas were due to each to faecal impaction, birth trauma, trauma from rectal enema procedure, iatrogenic following posterior sagittal ano-rectoplasty (PSARP) andsexual abuse respectively.&#x0D; Conclusion: The fistula healing outcome for acquired anorectal fistula in HIV positive cases was weak compared to the trauma-related groups.

HIV testing uptake and HIV positivity among presumptive tuberculosis patients in Mandalay, Myanmar, 2014-2017.

The World Health Organization's framework for TB/HIV collaborative activities recommends provider-initiated HIV testing and counselling (PITC) of patients with presumptive TB. In Myanmar, PITC among presumptive TB patients was started at the TB outpatient department (TB OPD) in Mandalay in 2014. In this study, we assessed the uptake of PITC among presumptive TB patients and the number needed to screen to find one additional HIV positive case, stratified by demographic and clinical characteristics. This was a cross-sectional study using routinely collected data of presumptive TB patients who registered for PITC services at the TB OPD between August 2014 and December 2017 in Mandalay. Among 21,989 presumptive TB patients registered, 9,796 (44.5%) had known HIV status at registration and 2,763 (28.2%) were people already living with HIV (PLHIV). Of the remainder, 85.3% (10,401/12,193) were newly tested for HIV. Patients <55 years old, those registered in 2014, 2015 and 2017, those employed and those having a history of TB contact had higher uptakes of HIV testing. Among 10,401 patients tested for HIV, 213 (2.1%) patients were newly diagnosed with HIV and this included 147 (69.0%) who were not diagnosed as having TB. The overall prevalence of HIV (previously known and newly diagnosed) among presumptive TB patients was 14.8% (2,976/20,119). The number needed to screen to find one additional HIV case was 48: this number was lower (i.e., a higher yield) among patients aged 35-44 years and among those who were divorced or separated. Uptake of HIV testing among eligible presumptive TB patients was high with four out of five presumptive TB patients being tested for HIV. This strategy detected many additional HIV-positive persons, and this included those who were not diagnosed with TB. We strongly recommend that this strategy be implemented nationwide in Myanmar.

People living with HIV and COVID-19: A report on 2 clinical cases from South Africa

The impact of HIV in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has not been well established. It is uncertain if outcomes are better or worse in these patients compared with COVID-19 patients with diabetes mellitus, hypertension and other chronic diseases. The course and outcome is also unknown in HIV-positive patients who are virally suppressed on antiretroviral treatment (ART) compared with those who are treatment-naive. We present two HIV-positive cases with COVID-19 pneumonia - one virally suppressed and the other newly diagnosed. Both patients had favourable outcomes.

PDL1 expression predicts therapeutic outcome in non metastatic anal squamous cell carcinoma (NMASCC).

4054 Background: NMASCC is a rising incidence disease with up to 30% of treatment failure to achieve complete response (CR) after standard chemoradiotherapy (CRT) leading to severe morbidity and death. Stage III-TNM, p53 mutations, HPV negativity, HIV infection are linked to treatment failure. We investigated the predictive/prognostic role of TNM, CR, HPV, PDL1 positivity and CD3/CD8 densities in NM-ASCC from a single institution. Methods: All 79 eligible consecutive NMASCC pts (available FFPE pre-treatment samples) seen from October-2009 to April-2019 having completed definitive CRT (50.4 Gy Pelvic Radiotherapy with Mitomycin-C 12mg/m2/IV/d1-5 / FU 1000mg/m2/d1-4 d29-32 (28%), Mitomycin-C/Capecitabine 825 mg/m2/bid (38%), Cisplatin 60 mg/m2/IV d1-29 and 5FU (34%) were analyzed. Mean age: 59 (range 26-87), 72% female, Stage III: 59%, HPV positive: 86% (HPV-16: 80%);14% HIV positive. IHC assessed by two pathologist for PD-L1 expression (ClonSP263) and CD3-CD8+ TILS densities (Clone 2GV6, Clone SP57). HPV-DNA assessed by PCR (BSGP5+/6+ multiplexed with beta-globin). Kaplan-Meier survival, CR, DFS, OS and Univariate analyses were performed using Cox proportional hazard model. Results: CR achieved within 6 months of treatment completion was 68%( 53pts). Median follow-up after treatment completion: 35 months (range 6 –149). As of February 2020, 82% (65 pts) are alive, no evidence of disease:(57%) 46 pts, recurrence rate: 26%(22 pts), cancer death: 18% (14 pts). PDL1+ tumors ( &gt; 1% positivity-CPS score): 56%, expression levels: 1-5% (57%,26p), &gt; 10%-100% (43%,19p). PDL1+ had a strong association with CR (p = 0.021); higher PDL1+ levels had 8-fold of CR-likelihood than PDL1 negative.(OR 8.50 vs. 1.12). Significative Spearman correlation between PDL1 tumors with CR and CD3-CD8 TILS density was observed (R = 0.43,p = 0.0017 and R = 0.36,p = 0.00094 respectively), albeit CD3-CD8 failed to reach significance as prognostic factors for either CR, DFS or OS. Only CR and PDL1 positive were strongly significantly associated to DFS (HR 0.10 [IC 95% 0.04-0.28] p &lt; 0.001 and HR 0.28 [IC 95% 0.11-0.73] p = 0.006) and OS (HR 0.12 [IC 95% 0.03-0.45] p &lt; 0.001 and HR 0.15 [IC 95% 0.03-0.68] p &lt; 0.004). Low prevalence of HPV negative, early tumors, HIV positive cases in our series probably impacted in statistical power for prognosis correlation. Conclusions: PDL1 positivity was the strongest predictive/prognostic factor in NM-ASCC. Alternative therapeutics options to standard CRT should be explored on poor-risk patients as HPV-negative, P53-mutated and PDL1 negative patients.

Trends in the incidence of the human immunodeficiency (HIV) virus in Chile, by age and gender 2010-2017

To determine the trends in the incidence of contagion by the HIV in Chile, according to age and gender, for the period 2010-2017. Analysis from the database of confirmed HIV positive diagnosis cases. HIV incidence rates were made from HIV-confirmed cases adjusted for year, age, and sex, with population denominators from the INE. A general and specific trend analysis was performed using regression equations. There is a trend to increase in HIV incidence rates in the study period. 36.48% of the reported cases correspond to the male sex between 20-29 years, group with the highest incidence in the period. The estimated regression equations effectively increase more steadily in the male and young population. There are deficit informative and educational factors in HIV prevention in the Chilean population. Despite the strong progression of new cases, the diagnostic gap of people living with HIV who are unaware of their health remains to be consolidated. Gaps were identified between recommendations, public policies and the Chilean results obtained.

Social Vulnerabilities and Reported Discrimination in Health Care Among HIV-Positive Medical Case Management Clients in New York City.

We aimed to investigate the extent to which social vulnerabilities correlated with lifetime experience of discrimination in healthcare among people with HIV (PWH) receiving services to improve treatment adherence and viral suppression. Individuals (N=687) enrolled in a Ryan White Part A medical case management program were surveyed about discrimination experienced in healthcare settings, reasons for any discrimination faced, and self-reported health. We merged data from the survey with data from the New York City HIV Surveillance Registry and a programmatic database to obtain client sociodemographic and clinical characteristics and reported history of social vulnerabilities. Thirty-nine percent of participants reported lifetime experience of discrimination in healthcare settings; individuals with a history of at least three social vulnerabilities (mental health diagnosis, incarceration, substance use, and/or housing instability) had more than twice the odds of reporting discrimination than individuals who did not report any of these social vulnerabilities (aOR, 2.33 [95% CI, 1.43 - 3.83]). Among individuals who reported discrimination in healthcare, those who cited HIV status or substance use as reasons for discrimination were significantly more likely to report a higher number of social vulnerabilities (p=0.04 and p=0.009, respectively), with discrimination due to HIV status most strongly associated with a mental health diagnosis. These findings underscore the importance of acknowledging life experience and psychosocial barriers in provider interactions with PWH. They also highlight a need for monitoring provider attitudes and behaviors regarding intersectional stigmas related not only to factors such as race and sexual orientation, but also to social vulnerabilities.