HIV-positive Females Research Articles

Cervical cancer screening practices in HIV positive females - a missing link in health care delivery in Pakistan.

To probe cervical cancer screening practices in local women positive for human immunodeficiency virus, and to determine the cervical cytological changes in them. The serial cross-sectional study was conducted at the Jinnah Hospital and Services Hospital, Lahore, Pakistan, from April 2019 to October 2020, and comprised female patients aged 18-45 years who were positive for human immunodeficiency virus or acquired immunodeficiency syndrome and were registered with the relevant programme being run by the provincial government in Punjab. Blood samples of all the patients were collected for the determination of human immunodeficiency virus viral load and cluster of differentiation 4+ count. Cervical smears were taken for cytopathological analysis, while the swabs were analysed for culture sensitivity. The same individuals were subjected to the same testing one year later, and the status of the disease and clinical stability or disease progression was explored. Data was analysed using SPSS 25. There were 150 women with mean age 32.08±7.13 years (range: 21-45 years). Age at marriage/sexual activity was 17.33±4.73 years in 15(10%) subjects. Cytological examination showed atypical squamous cells of undetermined significance in 6(4%) of the cases whereas 3(2%) cases showed atypical squamous cells, which cannot rule out high grade squamous intraepithelial lesion on cytology, while the rest were classified as negative for intraepithelial lesion or malignancy. Cervical microbial changes revealed methicillin-resistant staphylococcus aureus infection in 9(6%) cases, extended-spectrum beta-lactamase in 15(10%) cases, whereas fungal infection and trichomonas vaginalis infection were found in 30(20%) smears. There was a significant association between cluster of differentiation 4+ cell count and stability of high-risk patients (p<0.001). After one year, 84(56%) patients remained clinically stable, while 51(34%) developed some chronic illness. There was a significant association between cluster of differentiation 4+ cell count <200/mm3 and the risk of developing a chronic illness (p<0.001). There was a dire need to educate healthcare workers to offer regular cervical screening to patients with high-risk sexually-transmitted infections to prevent them from the morbidity and mortality related to cervical cancer.

Tuberculosis Mortalities Among In-patients at a Tertiary Hospital in Zambia Between 2018 and 2019 - The Spectrum of Clinical Presentations

Background: Tuberculosis (TB) has remained one of the most important public health diseases and a leading cause of mortality from a single infectious agent in the world. In-patient mortalities have remained relatively high despite massive investment towards TB elimination. This prompted us to undertake a TB mortality review aimed at understanding the spectrum of clinical presentations in TB mortalities among in-patients in a local hospital set up in Zambia.&#x0D; Methods: Files of 74 in-patient TB related mortalities that had occurred at Kitwe Teaching Hospital over a 12-month period between June 2018 and June 2019 were audited using a structured questionnaire. The data was analyzed using SPSS v 16.0 statistical software while descriptive statistics and cross tabulation was used to determine the frequencies and cross relationships among the variables followed by univariate logistic regression whose significance was set at a p-value of 0.05 and a 95 percent confidence interval. Variables that were found to be significant at univariate logistic regression were fitted into the multivariable logistic regression.&#x0D; Results: The audit revealed that 50 (67.6%) of the files were for male patients with a mean age of 39.2 ± 11.6 years. 60(80%) were HIV positive, 60(80%) resided in high-density residential areas. On presentation to hospital, the commonest symptoms included productive cough and fever [31(41.9%) and 30(40.5%) respectively]. HIV positive male patients were presenting in hyperdynamic state (mean pulse rate of 117.2 ± 32.4 per minute, p = .001) and HIV positive females presented with mean arterial pressure (72.3 ± 19.5 mmHg, p = .002). Other findings included signs of multi-organ involvement [hypoalbuminemia 9(12.2%), deranged renal function 8(10.8%) and deranged liver enzymes 9(12.2%)] before mortality occurred.&#x0D; Conclusion: The spectrum of clinical presentations among in-patients with TB in a tertiary hospital include the following; male gender, age younger than 50 years, being HIV positive, residing in a high-density residential area and presenting with unstable hemodynamics. There is a need to focus strategies targeted at strengthening early recognition of clinical instability among admitted TB patients for at-risk populations, including young to middle aged males who are HIV positive.

Contemporary Anti-Retroviral Drugs (ARVDs) Disrupt Follicular Development in Female Wistar Rats.

There are genuine concerns that long-term use of anti-retroviral drugs may be associated with reproductive complications in females. This study aimed to ascertain the effect of highly active anti-retroviral drugs on the ovarian reserve and reproductive potential of female Wistar rats and by extension to HIV-positive human females. A total of 25 female Wistar rats, weighing between 140g and 162g, were randomly allotted into non-intervention and intervention groups, receiving the anti-retroviral drugs, Efavirenz (EFV), Tenofovir Disoproxil Fumarate (TDF), Lamivudine (3TC), and a fixed-dose combination (FDC). The dosage was administered orally at 8 am daily for 4 weeks. Serum concentrations of anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinising hormone (LH), and estradiol were measured using standard biochemical techniques (ELISA). Follicular counts were made on fixed ovarian tissue from the sacrificed rats. The mean AMH level for the control group and the EFV, TDF, 3TC, and FDC groups were 11.20, 6.75, 7.30, 8.27, and 6.60 pmol/L, respectively. The EFV and FDC groups had the lowest AMH, compared to the other groups, but there was no statistically significant difference in AMH across the groups. The mean count of antral follicles was significantly lower in the group that received EFV when compared to the other groups. The corpus luteal count was significantly higher in the control group than in the intervention groups. The study demonstrated a disruption in the reproductive hormones of female Wistar rats receiving anti-retroviral regimens containing EFV. Clinical studies are required to determine if these changes are seen in women receiving EFV-based treatment, as this may compromise reproductive function and predispose them to early menopause.

Prevalence of HPV types in HIV-positive and negative females with normal cervical cytology or dysplasia.

The selected female population consisted of 65 already diagnosed HIV-positive females and 135 HIV-negative females. Cervical scrap was collected and analyzed for HPV and cytology. The prevalence of HPV in HIV-positive patients was 36.9%, higher than HIV-negative patients (4.4%). 12.30% had cervical cytology interpreted as "LSIL" and 87.69% had cytology interpreted as "NIL." The high-risk type was detected in 15.39% while 21.54% showed low-risk HPV types. Among the high-risk types, HPV18 (6.15%), HPV16 (4.62%), HPV45 (3.07%), HPV33 (1.53%), HPV58 (3.07%), and HPV68 (1.53%) were found. In patients with LSIL, high-risk HPV accounts for 62.5%. Risk factors, such as age, marital status, educational status, residence, parity, other STDs, and contraceptives, were analyzed to find the correlation with HPV infection Age ≤35 years (OR 1.21, 95% CI, 0.44-3.34), illiterate and incomplete secondary education (OR 1.08, 95% CI, 0.37-3.15), and those reported not to use contraceptives (OR: 1.90; 95% CI: 0.67-5.42) have an association for increased risk of HPV infection. HPV18, HPV16, HPV58, HPV45, HPV68, and HPV33 were identified among high-risk HPV types. High-risk HPV was detected in 62.5% of low-grade squamous intraepithelial lesions. The data is useful for health policymakers to develop a strategy for HPV screening and prophylactic vaccination to prevent cervical cancer.

Overweight and obesity in south central Uganda: A population-based study.

Obesity is a rapidly growing global health challenge, but there are few population-level studies from non-urban settings in sub-Saharan Africa. We evaluated the prevalence of overweight (body mass index (BMI)>25 kg/m2), obesity (BMI>30 kg/m2), and associated factors using data from May 2018 to November 2020 from the Rakai Community Cohort Study, a population-based cohort of residents aged 15 to 49 living in forty-one fishing, trading, and agrarian communities in South Central Uganda. Modified Poisson regression was used to estimate adjusted prevalence risk ratios (PRR) and 95% confidence intervals (CI) in 18,079 participants. The overall mean BMI was 22.9 kg/m2. Mean BMI was 21.5 kg/m2 and 24.1 kg/m2 for males and females, respectively. The prevalence of overweight and obesity were 22.8% and 6.2%, respectively. Females had a higher probability of overweight/obesity (PRR: 4.11, CI: 2.98-5.68) than males. For female participants, increasing age, higher socioeconomic status, residing in a trading or fishing community (PRR: 1.25, CI 1.16-1.35 and PRR: 1.17, CI 1.10-1.25, respectively), being currently or previously married (PRR: 1.22, CI 1.07-1.40 and PRR: 1.16, CI 1.01-1.34, respectively), working in a bar/restaurant (PRR: 1.29, CI 1.17-1.45), trading/shopkeeping (PRR: 1.38, CI 1.29-1.48), and reporting alcohol use in the last year (PRR: 1.21, CI 1.10-1.33) were risk factors for overweight/obese. For male participants, increasing age, higher socioeconomic status, being currently married (PRR: 1.94, CI 1.50-2.50), residing in a fishing community (PRR: 1.68, CI 1.40-2.02), working in a bar/restaurant (PRR: 2.20, CI 1.10-4.40), trading/shopkeeping (PRR: 1.75, CI 1.45-2.11), or fishing (PRR: 1.32, CI 1.03-1.69) increased the probability of overweight/obesity. Non-Muslim participants, male smokers, and HIV-positive females had a lower probability of overweight/obese. The prevalence of overweight/obesity in non-urban Ugandans is substantial. Targeted interventions to high-risk subgroups in this population are needed.

SOCIAL RELATIONS, SUICIDAL PROBABILITY AND QUALITY OF LIFE OF HIV POSITIVE INDIVIDUALS

The present study intended to observe the connection between social relations, suicidal probability, and quality of life among HIV (Human Immunodeficient Virus) positive individuals. This study was conducted at Government College University Faisalabad from April 2016 to February 2017. A sample has consisted of 100 diagnosed as HIV positive married men and married women with age ranging from 22 to 50 years old (M = 33.3, SD = 7.2). Data was collected using purposive sampling. To measure the variables e.g. social relations, suicidal probability, and quality of life, the Provision of Social Relations Scale (PSR), Suicidal Probability Scale (SPS), and Quality of Life (QOL) Scales were used. Linear Regression along with an independent sample t-test was run to analyze data by using SPSS 22. Results of Linear Regression analysis indicated that the total score of social relations significantly negatively predicted suicidal probability but positively predicted the four domains of quality of life (physical, psychological, social, and environment). While Suicidal probability negatively contributed to the quality of life. The findings of the t-test showed that HIV-positive males had better social relations as well as a quality of life than HIV-positive females. There was also a significant gender difference in the level of suicidal probability as women scored high than men. The study emphasized the importance of social relations especially care from family. Better social relations predicted better quality of life. Better social relations predicted low suicidal probability. Keywords: HIV, Social Relation, Suicidal Probability, Quality of Life.

Factors associated with active syphilis among men and women aged 15 years and older in the Zimbabwe Population-based HIV Impact Assessment (2015-2016).

Ulcerative STIs, including syphilis, increase the risk for HIV acquisition and transmission due to the presence of ulcers/chancres that serve as a point-of-entry and exit for HIV. In Zimbabwe, diagnosis of syphilis often occurs in pregnant women who seek ANC services where syphilis testing is offered, and among men and women who seek health care for STIs. Zimbabwe's national syphilis estimates are based on these diagnosed cases, with little information available about the prevalence of untreated syphilis among the general population. This analysis uses data from ZIMPHIA (2015-2016) to describe factors associated with active syphilis among men and women ages 15 years and older. ZIMPHIA collected blood specimens for HIV and syphilis testing from 22,501 consenting individuals (ages 15 years and older). Household HIV testing used the national HIV rapid-testing algorithm with HIV-positive results confirmed at satellite laboratories using Geenius HIV-1/2 rapid test (Bio-rad, Hercules, California, USA). Point-of-care non-Treponemal and Treponemal syphilis testing was performed using Chembio's Dual-Path Platform Syphilis Screen & Confirm Assay. Factors associated with active syphilis were explored using multiple variable, weighted logistic regression and were stratified by gender. The likelihood of active syphilis in HIV-positive females was 3.7 times greater in HIV-positive females than HIV-negative females (aOR: 3.7, 95% CI 2.3-5.9). Among males odds of having active syphilis was 5 times higher among those that engaged in transactional sex than those who did not have sex or transactional sex (aOR: 5.3, 95% CI 1.9-14.7), and 6 times higher if HIV positive versus negative (aOR: 5.9, 95% CI 3.0-12.0). Urban residence, province, education (highest attended), marital status, number of sex partners, consistency of condom use, pregnancy status (females), and circumcision status (males) were not significant in the adjusted model for either females or males. HIV status was found to be the only factor associated with active syphilis in both females and males. Given the persistent link between HIV and active syphilis, it is prudent to link individuals' diagnoses and treatments, as recommended by the WHO. Enhanced integration of STI and HIV services in health delivery points such as ANC, reproductive services, or male circumcision clinics, combined with consistent, targeted outreach to high-risk populations and their partners, may assist the MOHCC to eliminate active syphilis in Zimbabwe.

Interaction of sex and HIV infection on renal impairment: baseline evidence from the CHART cohort

ObjectiveFemales are more vulnerable to renal impairment (RI) in people living with HIV (PLWH), but few studies have examined sex disparity in the association of HIV serostatus with RI. MethodsIn total, 2,101 PLWH on antiretroviral treatment (ART) and 4,202 HIV-negative people were selected and frequency matched in 1:2 ratio by sex and age categories. RI was defined as estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2. The interaction effect of sex with HIV serostatus and correlates of RI were assessed by logistic regression models. ResultsIn total, 78.2% of participants were males with median age 43.7 (IQR: 32.5-54.4) years. The prevalence of RI was comparable for PLWH and HIV-negative people overall (30.4% vs 30.1%) but significantly higher for HIV-positive females (37.1%) than HIV-negative females (30.1%). Multiple logistic regression identified an interaction between sex and HIV serostatus on RI (adjusted odds ratio [aOR] of the interaction term: 1.66, 95% CI: 1.23-2.26). HIV infection was significantly associated with RI in females (aOR: 1.55, 95% CI: 1.17-2.06) but not in males. Central obesity and nadir CD4 count were significantly associated with RI in HIV-infected females but not in HIV-infected males. ConclusionsSex seems to modify the association between HIV infection and RI, suggesting a sex-specific mechanistic pathogenesis of RI in PLWH, which warrants further investigation and intervention.

What influences uptake and early adherence to Option B+ (lifelong antiretroviral therapy among HIV positive pregnant and breastfeeding women) in Central Uganda? A mixed methods study.

High uptake and optimal adherence to Option B+ antiretroviral therapy (ART) increase effectiveness in averting mother-to-child transmission of HIV. Option B+ ART uptake, early adherence, and associated factors need to be evaluated in Central Uganda. A mixed approaches study was carried out in six health facilities in Masaka, Mityana, and Luwero districts from October 2013 to February 2016. Questionnaires were administered to 507 HIV positive pregnant females seeking antenatal care services. Key informant interviews were conducted with 54 health providers, and in-depth interviews (IDIs) with 57 HIV positive women on Option B+ ART. Quantitative data were analyzed using log-binomial regression model to determine factors associated with optimal adherence (taking at least 95% of the prescribed ART), while thematic analysis was used on qualitative data. Ninety one percent of women (463/507) received a prescription of life long ART. Of these, 93.3% (432/463) started swallowing their medicines. Overall, 83% of women who received ART prescriptions (310/374) felt they were ready to initiate ART immediately. Main motivating factors to swallow ART among those who received a prescription were women's personal desire to be healthy (92.3%) and desire to protect their babies (90.6%). Optimal adherence to ART was achieved by 76.8% (315/410). Adherence was higher among females who were ready to start ART (adj. PR = 3.20; 95% CI: 1.15-8.79) and those who had revealed their HIV positive result to someone (adj. PR = 1.23; 95% CI: 1.04-1.46). Facilitators of ART uptake from qualitative findings included adequate counseling, willingness to start, and knowing the benefits of ART. Reasons for refusal to start ART included being unready to start ART, fear to take ART for life, doubt of HIV positive results, and preference for local herbs. Reasons for non-adherence were travelling far away from health facilities, fear of side effects, non-disclosure of HIV results to anyone, and perception that the baby is safe from HIV infection post-delivery. Uptake of Option B+ ART was very high. However, failure to start swallowing ART and sub-optimal adherence are a major public health concern. Enhancing women's readiness to start ART and encouraging HIV result revelation could improve ART uptake and adherence.

Prevalence of HBV co-infection in HIV-positive population in China: a systematic review and Meta-analysis

Objective: To reveal the epidemiologic characteristics of hepatitis B virus (HBV) infection in HIV positive population in China. Methods: We collected research papers published from 2010 to 2019 on HBV co-infection in HIV positive population in China through literature retrieval, screening and quality evaluation. The Meta-analysis was conducted after extracting relevant data from the research papers meeting the inclusion criteria. Results: Twenty-seven studies were included with 69 816 samples. The pooled HBV infection rate in HIV positive population in China was 11.29%. The HBV co-infection rate was higher in the western China (10.73%) and southern China (14.18%), while lower in northern China (6.36%). The HBV infection rates were 11.22%, 12.76%, 9.58%, 11.32% and 10.34%, respectively, in HIV-positive population infected through blood or blood products transfusion, intravenous drug use, homosexual contact, heterosexual contact and unknown transmission routes. Population infected with HIV caused by mother-to-child transmission had the lowest HBV infection rate (2.87%). The HBV infection rate in HIV positive males was 1.29 times higher than that in HIV positive females in southern China. Conclusions: The HBV infection rate in HIV positive population is significantly higher than that in general population. More attention should be paid to the prevention and control of HBV co-infection in HIV positive population.

CD8 encephalitis with CSF EBV viraemia and HIV drug resistance, a case series

IntroductionCD8 encephalitis is a relatively recently described condition in the setting of HIV infection. It is becoming increasingly recognised in recent years though is still likely underdiagnosed. MethodsWe present three cases of encephalitis in HIV-positive black African females initially presenting with neurological pathology. Two cases concern recent presentations of patients attending HIV services at a large tertiary referral hospital and the third case involves a retrospective analysis of an archived case. Results and discussionMRI brain demonstrated periventricular white matter changes in 2 cases and a cerebellar lesion in the third case. CSF examination revealed lymphocytosis and elevated protein levels. CSF HIV viral load analysis showed viral escape along with new antiretroviral drug resistance mutations. CSF flow cytometry studies demonstrated a reversed CD4:CD8 ratio with a high CD8+ cells percentage. All patients had EBV DNA detected in their CSF. Brain biopsy in two patients confirmed CD8 encephalitis and also revealed isolated cells demonstrating EBV positivity by in-situ hybridization using EBER (Epstein–Barr virus-encoded small RNAs). Treatment with steroids and ART optimisation led to significant clinical and radiological improvements in all cases. DiscussionCD8 encephalitis should be considered as a cause of neurological symptoms and confusion in the HIV-positive patient, particularly if poor ART adherence or viral resistance are suspected. Brain biopsy should be considered in HIV-positive patients with encephalopathy of uncertain cause. Early treatment with high-dose corticosteroids when suspecting this diagnosis is essential for a favourable outcome. The prognosis is variable but can be favourable even following severe encephalopathy. The presence of new INSTI mutations in the CSF but absent peripherally in two INSTI-era patients is a novel finding for this case series in the context of CD8 encephalitis. The role played by EBV in this disease remains unclear and warrants further investigation.

High Acceptability of Assisted Partner Notification Services Among HIV-Positive Females in Kenya: Results From an Ongoing Implementation Study.

Assisted partner services (aPS) involves notification and HIV testing for sexual partners of persons diagnosed HIV-positive (index clients). Because the impact of aPS is contingent on high acceptance, we assessed characteristics and reasons for nonenrollment among female index clients in an ongoing scale-up project. We analyzed data from HIV-positive females offered aPS in 31 facilities from May 2018 to August 2019. We compared sociodemographic characteristics by aPS enrollment (accepted, refused, and ineligible) and used multivariate binomial regression to assess associations between demographics and refusal. Twenty-four thousand four hundred eighteen females received HIV testing and 1050 (4.3%) tested HIV-positive; 839 females enrolled in aPS (80%), 59 refused (6%), and 152 were ineligible (14%). APS uptake did not differ by age, testing history, or testing type (provider initiated vs. client initiated). Females refusing aPS were more likely to have completed secondary school [adjusted relative risk (aRR) 2.03, 95% confidence interval (CI): 1.13 to 2.82] and be divorced/separated (aRR: 3.09, 95% CI: 1.39 to 6.86) or single (aRR: 2.66, 95% CI: 1.31 to 5.42) compared with married/cohabitating. Reasons for refusing aPS included not feeling emotionally ready (31%) and reporting no sexual partners in past 3 years (22%). Reasons for ineligibility included fear or risk of intimate partner violence (9%), previous HIV diagnosis (9%), or insufficient time for aPS provision (3%). APS has high acceptability among HIV-positive females regardless of age or testing history. More counseling may be needed to increase uptake among females with higher education and those who are separated/single. Follow-up for females not emotionally ready or who had insufficient time for aPS in their clinic visit can improve coverage.

Toxoplasmosis Among HIV Patients and Healthy Volunteers in Port Harcourt, Rivers State, Nigeria

Background: Toxoplasmosis is a serious infection, especially among the immune-compromised people such as HIV/AIDS patients. Objectives: This study assessed the seroprevalence and associated risk factors of toxoplasmosis among HIV patients and healthy volunteers or immuno-competent persons (IP) in Port Harcourt. Methods: A total of 400 (200 per group) randomly-selected sera were tested for IgG and IgM T. gondii antibodies using ELISA technique. CD4 cell counts were also determined. Demographic and risk factors were determined using a well-structured questionnaire. Results: Overall seroprevalence for HIV and IP using IgG and IgM toxoplasma antibodies was 36.0%, 21.5%, and 1.5%, 7.0%, respectively. The age group f 40 years and above had the highest seroprevalence of 25.3% among the HIV positive persons, while the age groups 25 - 29 years had the highest seroprevalence of 20.0% among the IP. Traders’ positive with HIV had the highest seroprevalence of 30.0% and 0.9% for IgG and IgM toxoplasma antibodies, respectively. HIV subjects with a secondary education showed the highest seroprevalence of 20.0%. More HIV positive females were infected with toxoplasmosis 18.5%. In all, 6.7% (P &gt; 0.05) of the seropositive patients had CD4 cell counts of less than 200 cells/µL, indicating no correlation between seroprevalence and CD4 cell counts of HIV/AIDS patients. Risk factors in this study included the history of living with pets, farming and eating improperly-washed fruits and vegetables. Conclusions: Seroprevalence of Toxoplasmosis was high among HIV patients in Port Harcourt. It is suggested that the institutions included the Toxoplasmosis test as one of the routine tests for HIV patients.

Burden of Sexually Transmitted Infections (STI) in Rural and Peri-Urban KwaZulu-Natal, South Africa: Findings from a Population-Based Household Survey

Background: Sexually transmitted infections (STI) contribute to enhancing HIV transmission and acquisition; however, population level prevalence of STI from high HIV burden settings are limited Methods: A population-based household survey undertaken between June 2014 and June 2015 enrolled 15–49 year old males and females in the Vulindlela and Greater Edendale areas of KwaZulu-Natal, South Africa. Data collected includedself-reported sociodemographic, behavioral, and clinical variables. For curable STIs, first-pass urine (males) or self-collected vulvo-vaginal swabs (females) were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium using multiplex real-time polymerase chain reaction (PCR) and for syphilis serum sample was tested using a non-treponemal rapid plasma reagin (RPR) assay. Herpes simplex virus type 2 (HSV-2) and HIV antibodies were assessed by enzyme-linked immunosorbent assays. Prevalence of all STIs was measured and the association between participant characteristics and curable STIs was estimated using Poisson regression. Findings: Among the 9812 enrolled participants, 38·9% were under the age of 25 years and 63·9% were females. Among males and females, the prevalence of HIV was 28·0% and 44·1%, p<0·001; HSV-2 was 46·1% and 68·8%, p<0·001. Overall, 15·5% of males and 27·8% of females tested positive for any curable STI; syphilis was 1·5% and 1·7%, p=0·62; N. gonorrhoeae 1·8% and 3·7%, p<0·001; C. trachomatis was 5·1% and 9·0%, p<0·001; T. vaginalis was 3·9% and 13·8%, p<0·001 and M. genitalium was 5·7% and 5·2%, p=0·43. Most STIs were higher in females and in HIV positive individuals. Infection with curable STIs in males was associated with age, drug use, and HIV positive status. In females, infection was associated with age, relationship status, number of lifetime partners, concurrent relationship, alcohol use, and HIV status. Viral suppression was associated with lower STI prevalence in both HIV positive males and females. Conclusions: The prevalence of curable STIs, HSV-2 and HIV was high in this population. These findings have important public health implications for HIV transmission and acquisition and justify the importance of population-based surveillance to monitor STIs in order to reduce STI related morbidity and mortality, improve the quality of sexual and reproductive health, and to reduce the STI and HIV syndemic. Funding Statement: Supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of operative agreement 3U2GGH000372-02W1. ABMK is supported by the joint South Africa–US Program for Collaborative Biomedical Research from the National Institutes of Health (R01HD083343). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The protocol, informed consent and data collection forms were reviewed and approved by the Biomedical Research Ethics Committee of the University of KwaZulu-Natal, (Reference number BF269/13), and the KwaZulu-Natal Provincial Department of Health (HRKM 08/14). The protocol was also reviewed in accordance with the Centers for Disease Control and Prevention (CDC), United States of America human research protection procedures and was determined to be research, but CDC investigators did not interact with human subjects or have access to identifiable data or specimens for research purposes.

Elderly HIV-positive women: A gender-based analysis from the Multicenter Italian "GEPPO" Cohort.

BackgroundHIV-positive patients are facing age-and disease-related comorbidities. Since gender differences in viro-immunological, clinical and therapeutic features have been described, aim of this analysis was to explore such differences in elderly HIV-positive females compared to males coming from the same cohort.DesignCross-sectional study.SettingTen Infectious Diseases Center participating to a new multicenter Italian geriatric Cohort aiming at describing health transition over time in HIV-positive individuals.ParticipantsHIV-positive patients aged ≥65 years old.MeasurementsWe recorded clinical, viro-immunological and therapeutical data.ResultsWe included 210 women (17%) out of 1237 patients. Compared to males, elderly females were less likely to present a HIV-RNA <50 copies/mL (74.3% vs. 81.8%, OR 0.64, 95%CI 0.44–0.93); they showed higher CD4+/CD8+ ratio (p = 0.016). Combined antiretroviral therapy (cART) strategies were similar between genders (p>0.05), although women were less likely to be treated with protease Inhibitors (PIs) (p = 0.05); specifically, in triple-drug regimens females received less PIs (28% vs 38% p = 0.022) and more integrase inhibitors (30% vs. 20% p = 0.012). Bone disease was more common in females (p<0.001) while males presented more frequently cardiovascular disease (CVD) (p<0.001). In females with bone disease, PIs and boosted regimens (38% vs. 53.7% p = 0.026 and 30.4 vs 44.0% p = 0.048 respectively) were prescribed less frequently. Polypharmacy was common and similar in both genders (20% vs. 22.8%, p = >0.05). A higher use of lipid-lowering drugs (20.5% vs. 14.8%, p = 0.04) was observed in females and yet they were less likely to receive anti-thrombotic agents (18.6% vs. 26.3%, p = 0.019) even when CVD was recorded (57.1% vs. 83.1%, p = 0.018). In multivariate analysis, we found that female gender was independently associated with a higher CD4+/CD8+ ratio but not with virological suppressionConclusionsElderly HIV-positive women display a worse virologic response despite a better immune reconstitution compared to males. The burden of comorbidities as well as the medications received (including cART) may slightly differ according to gender. Our data suggest that more efforts and focused interventions are needed in this population.

Prevalence and Correlates of Psychological Distress Among HIV Positive Individuals in South Africa: Findings from the 2012 HIV National Household Survey

Psychological distress symptoms like depression and anxiety are potentially dangerous conditions in HIV positive individuals influencing health-seeking behaviour, care and treatment leading to poor health outcomes. This study sought to determine the prevalence of psychological distress symptoms and associated socio-demographic and health-related factors amongst HIV positive individuals. The study used the 2012 data from a nationwide cross-sectional population-based household survey that was conducted using a multi-stage stratified cluster sampling design. Bivariate and multivariate logistic regression analysis were used to identify factors associated with psychological distress among HIV positive individuals. Of 2 536 HIV infected individuals found in the study, 34.5% reported psychological distress symptoms. The prevalence of reported psychological distress symptoms was significantly higher among females (38.2%) than males (28.5%). Increased likelihood of psychological distress among HIV positive males was significantly associated with residing in urban informal areas than urban formal areas [OR=2.5(95% CI: 1.2-5.6), p=0.021], not engaging in vigorous intensity sport [OR=2.1 (95% CI: 1.2-3.8), p=0.009]. The decreased likelihood was significantly associated with being employed [OR=0.6 (95% CI: 0.4-1.0), p=0.066], not having any chronic condition [OR=0.5(95% CI: (0.3-1.0), p=0.037], and low risk drinkers than hazardous drinkers [OR=0.3(95% CI: 0.1-0.9), p=0.036]. Among HIV positive females, increased likelihood of psychological distress was significantly associated with never seeing a health personnel [OR=2.8 (95% CI: 1.2-6.7), p=0.022]. The decreased likelihood was significantly associated with seeing a health personnel more than one year ago than in the past 6 months [OR=0.7 (95% CI: 0.4-1.0), p=0.051], and not having any chronic conditions [OR=0.6 (95% CI: 0.5-0.9), p=0.017]. The findings suggest a need for integrated interventions including those addressing mental health issues which target HIV positive individuals in urban informal areas, the unemployed, hazardous risk drinkers, and those with chronic medical conditions.

A Study of Pap Smears in HIV-Positive and HIV-Negative Women from a Tertiary Care Center in South India

Objectives: The aim of this work was to study the spectrum of epithelial abnormalities on Pap smears of HIV-positive women categorized as per the Bethesda System of Reporting Cervical Cytology, to correlate them with CD4 lymphocyte counts, and to compare them with the spectrum of abnormalities seen in a HIV-negative control group. Study Design and Methodology: The present study was a 6-year retrospective study conducted in the Department of Pathology at Kasturba Medical College, Mangalore, which included 150 Pap smears from HIV-positive and HIV-negative women, respectively. The Pap-stained slides of the cases were retrieved and studied. The data collected were tabulated and analyzed. A statistical study was performed using SPSS software. The χ² test was used to analyze the data and a p value < 0.05 was considered to be significant. Results: Pap smear abnormalities were twice as high in HIV-infected women (12%) as compared with HIV-negative women (6%; p = 0.006, RR = 2). Negative for intraepithelial lesion/malignancy was the most common finding (88%), which was further subdivided into inflammatory, atrophic smear, non-specific, candidiasis, and bacterial vaginitis groups. The percentage of epithelial abnormalities was 12%, including: atypical squamous cells of undetermined significance, 5.55%; atypical squamous cells, cannot exclude HSIL, 16.66%; low-grade squamous intraepithelial lesion, 5.55%; high-grade squamous intraepithelial lesion (HSIL), 61.11%, and squamous cell carcinoma, 11.11%. The highest incidence of intraepithelial lesions in HIV-positive females was in the age group of 34–49 years. CD4 cell counts fell in the range of 200–500 cells/mm³ in most of the HIV-positive patients (68.75%), but was not found to be statistically significant. Conclusion: Routine Pap smear examination is advocated in women with HIV as the prevalence of epithelial cell abnormalities was found to be 12%, which was twice as high as compared to the HIV-negative control group. Although there was no correlation of epithelial cell abnormalities with CD4 counts, a higher rate of the cases with epithelial abnormalities were observed to have CD4 cell counts of 200–500 cells/mm³.

Clinical and Psychosocial Characteristics of HIV-Positive and HIV-Negative Females with Opiate Dependence

The objective of the study was to explore the clinical-psychological and social characteristics of injecting drugs women users (IDWU) with opiate dependence with different HIV status living on the territory of the Republic of Belarus based on multi-dimensional assessment of opiate dependence dynamics in order to develop therapeutic measures for relapse prevention and achievement of the long-term remission. Materials and methods: Totally 217 IDWU were examined. The research cohort was randomized into 2 groups: HIV-positive women (HPW) (104 persons, mean age 30.8 years (SD=4.86) and HIV-negative women (HNW) (113 persons, mean age 29.9 years (SD=6.67). The level of patients social functioning, quality of life, craving for narcotic substances were studied by means of the Scale of the social and functioning, SF-36 and the Scale of the craving for drugs. The particularities of the social functioning and life quality of women with opiate addiction and different HIV status were described. The results: show that the majority of IDWU were characterized by frequent work replacement and labor skipping (27/25.9% in HPW group vs 30/26.5% in HNW group; P&gt;0.05). 21 /20.1% HPW vs 15/13.2% HNW (P&lt;0.05) was characterized by low qualification, 43/43.3% HPW vs 41/36.2% HNW (P&gt;0.05) - vocational education. HPW have more severely impaired psychosocial parameters compared to HNW. Family climate can be described as hostile aggressive (84/80.7% in HNW group vs 69/61.0% in HNW group; P&lt;0.05). For women of both groups were characteristic parental alcohol abuse (18/17.3% in HPW vs 16/14.1% in HNW; P&gt;0.05), and high level of parental divorces (24/23.1% in HPW vs 32/28.3% in HNW; P&gt;0.05). It was found that the treatment itself allows to diminish the problems associated with drug use and HIV infection. Nevertheless, the short-term treatment course can only provide the clinical improvement but not stabilization of psychosomatic state of HIV-positive patients with opiate dependence. Conclusions: The results of the study indicates the vast majority of women who are injecting drug users, living in Belarus, can be characterized by high level of social functioning disturbances including domestic, social and professional relationship. They need for development of specific tactics of management to suit their needs, including the long-term complex treatment and rehabilitation programs.

Awareness of Cervical Cancer among HIV Positive Women in Southern India

Background: Cervical cancer is a major problem in developing countries. Women with HIV have a higher risk for the development and progression of cervical cancer.Combination anti retroviral therapy (cART) is freely available in our country since 2004 through antiretroviral therapy (ART) centres. It is expected that HIV-positive women attending ART centres should have good knowledge of cervical cancer. There is hardly any data from India regarding awareness of cervical cancer among females attending ART centre. This study was done to assess the awareness of cervical cancer among HIV positive women attending ART centre in Southern India. Methods: Using a cross-sectional study design, 111 HIV positive females attending ART centre in South India for at least 6 months were interviewed using a questionnaire. Descriptive statistics was calculated with the mean for variables that were normally distributed. To compare proportions, chi-square (χ2) statistics was used. Statistical analyses were performed with SPSS software. A p value < 0.05 was considered statistically significant. Results: The mean age of the study population was 39.12± 7.49 years. Majority of the study population 89 (80.1%) was literate. In our study 62 (55.9%) were housewives. Out of 111 patients only 27 (24.3%) had heard about cervical cancer. In our study 20(74.1%) had heard about cervical cancer from the treating doctor. Counselor in ART centre did not give them information about cervical cancer during post HIV test counseling or during subsequent visits. Out of 27, 15 (55.55%) of them had heard about Pap smear test , only 6 (22.22%) out of 27 had a Pap smear done. 6 (22.22%) out of 27 had heard about the HPV vaccine. Housewives were more aware of cervical cancer than working women which was statistically significant. Conclusions: The awareness of cervical cancer among patients attending the ART centre was low ,It is clear from our study that educating women about cervical cancer is not a priority at HIV clinics and ART centres. HIV counselors and doctors must educate HIV positive women attending ART centre about cervical cancer.

861. Health Disparities in HIV and Pregnancy

BackgroundHIV infection in pregnant females confers a higher risk of morbidity and obstetric complications. Widespread use of anti-retroviral therapy (ART) has dramatically decreased vertical HIV transmission. US HIV-infected pregnant females continue to be at higher risk for obstetric complications compared with nonHIV infected females. This study will be conducted with the objective to estimate the current US morbidity and mortality in HIV-infected pregnant females as well as incidence of obstetric complications in this patient population.MethodsThe National Inpatient Sample (NIS) was utilized to identify hospitalizations associated with pregnancy from 2002 to 2014. The aggregation of hospitalizations was stratified into 2 groups based on HIV status to determine whether there were differences in demographic factors, complications, and mortality. All analyses accounted for the NIS sampling design.ResultsThere were 39,404,956 pregnancy-related hospitalizations identified; of which, 51,762 were also associated with a positive HIV status. There were differences in complications for those with and without HIV, which included eclampsia (1.27% vs. 0.45%; P < 0.001), preterm labor (11.81% vs. 6.41%; P < 0.001), gestational diabetes (0.92% vs. 0.38%; P < 0.001), group B strep (0.03% vs. <0.01%; P < 0.001), and Gram-negative infection (0.07% vs. 0.03%; P = 0.013). After adjusting for mortality risk, calendar year, age, race and ethnicity, insurance, and zip-code level income, it was found that a positive HIV status was associated with a 91.1% increased odds of mortality (95% CI: 3.9%–351.5%; P = 0.037).ConclusionAs ART are readily available, we expected better outcomes for our HIV-positive pregnant females. Our results are concerning that there is such an increase rate of mortality and health disparity in HIV-positive pregnant females. As this is a retrospective study, there are limitation and further studies need to be conducted.Disclosures All authors: No reported disclosures.