HIV Risk Group Research Articles

ТЕНДЕНЦИИ РАЗВИТИЯ ЭПИДЕМИОЛОГИЧЕСКОГО ПРОЦЕССА ВИЧ-ИНФЕКЦИИ В КУРСКОЙ ОБЛАСТИ С 2014 ПО 2022 ГОД

Significance. Despite a favorable situation regarding HIV infection in the Kursk region, analyzing trends in HIV epidemiological process is relevant to prevent deterioration of the epidemiological situation. The knowledge of trends will make it possible to improve HIV prevention, as well as curb the spread of HIV infection. The purpose of the study was to identify trends in HIV epidemiological process in the Kursk region from 2014 to 2022. Material and methods. Data from newsletters of the Center for AIDS Prevention and Control (AIDS Center) of the Kursk Region for 2014-2022 were analyzed. A comparative analysis of the populations tested for HIV infection was carried out, the number of newly diagnosed HIV-seropositive cases and the gender and age structure of HIV-infected people were analyzed in order to develop additional preventive measures aimed at curbing the spread of HIV infection. Methods of descriptive and analytical statistics were used. Significance of differences was assessed at p<0.05. Results. In the Kursk region, the number of people tested for antibodies to HIV infection was on the rise from 228,030 people in 2014 to 360,624 people in 2022, while HIV detection since 2018 has been decreasing from 120.7 to 56.0 per 100,000 patient sera tested in 2022. The overwhelming number of the tested do not belong to HIV risk groups (96.7% in 2022), while the largest group in size among them is the “others” group (35.8% in 2022), which has increased 3-fold in nine years. The number of the tested belonging to HIV risk groups is decreasing, while the detection rate in such groups is eight-fold higher than among individuals not belonging to risk groups. The gender structure of HIV-infected people remains stable with men prevailing (62.9% in 2022). The age structure of newly diagnosed HIV cases is dominated by ages from 30 to 39 (34.7% in 2022), but its share is decreasing and the share of groups aged 40-49 (31.8% in 2022) and 50 years and older is growing (17.6% in 2022). Conclusion. In the Kursk region, the number of people tested for antibodies to HIV infection is constantly growing (by 132,594 people from 2014 to 2022 (41.9%)). The region has seen a decrease in the number of newly diagnosed HIV-seropositive cases since 2018 from 120.7 to 56.0 per 100,000 patient sera tested in 2022. The gender and age structure of HIV-infected persons is dominated by men aged 30-39. For early detection of HIV infection, it is necessary to include ELISA testing in the list of examinations during regular health check-ups and medical examinations of the working-age population.

Sex, Age, and Risk Group Variations among Individuals Infected with HIV, HTLV-1, and HTLV-2: Review of Data Records (1983–2017) from a Public Health Laboratory in São Paulo, Brazil

The inaugural AIDS Program in Brazil was established in São Paulo in 1983, with the Instituto Adolfo Lutz appointed for laboratory assistance. Subsequently, research on HIV infections and HIV/HTLV (HIV/HTLV-1 and HIV/HTLV-2) co-infections was conducted. This narrative review focuses on studies from the Immunology Department (1983–2017) that significantly influenced AIDS diagnosis or provided epidemiological data such as prevalence rates, sex, age, and risk factors. Twelve studies, encompassing over 8000 individuals, are discussed. During 1983–1985, nearly all AIDS cases were attributed to homosexual/bisexual men aged 31 years old. Subsequently, heterosexual men and women emerged as risk groups owing to intravenous drug use (IDU) and/or unprotected sexual intercourse with AIDS patients or multiple partners per year. From 1985 onwards, vertical transmission led to child infections. HIV/HTLV co-infection rates decreased over time, initially associated with male IDU, and in the 2010s with female IDU, and individuals aged >40 years. Trends in HIV and HIV/HTLV co-infections among younger men and women (<30 years of age) were observed from 2015 to 2017. The changing characteristics and risk groups for HIV and HIV/HTLV co-infections over the years underscore the necessity for ongoing public policies to prevent retrovirus transmission, particularly among adolescents and young adults.

Spatio-temporal estimates of HIV risk group proportions for adolescent girls and young women across 13 priority countries in sub-Saharan Africa.

The Global AIDS Strategy 2021-2026 identifies adolescent girls and young women (AGYW) as a priority population for HIV prevention, and recommends differentiating intervention portfolios geographically based on local HIV incidence and individual risk behaviours. We estimated prevalence of HIV risk behaviours and associated HIV incidence at health district level among AGYW living in 13 countries in sub-Saharan Africa. We analysed 46 geospatially-referenced national household surveys conducted between 1999-2018 across 13 high HIV burden countries in sub-Saharan Africa. Female survey respondents aged 15-29 years were classified into four risk groups (not sexually active, cohabiting, non-regular or multiple partner[s] and female sex workers [FSW]) based on reported sexual behaviour. We used a Bayesian spatio-temporal multinomial regression model to estimate the proportion of AGYW in each risk group stratified by district, year, and five-year age group. Using subnational estimates of HIV prevalence and incidence produced by countries with support from UNAIDS, we estimated new HIV infections in each risk group by district and age group. We then assessed the efficiency of prioritising interventions according to risk group. Data consisted of 274,970 female survey respondents aged 15-29. Among women aged 20-29, cohabiting (63.1%) was more common in eastern Africa than non-regular or multiple partner(s) (21.3%), while in southern countries non-regular or multiple partner(s) (58.9%) were more common than cohabiting (23.4%). Risk group proportions varied substantially across age groups (65.9% of total variation explained), countries (20.9%), and between districts within each country (11.3%), but changed little over time (0.9%). Prioritisation based on behavioural risk, in combination with location- and age-based prioritisation, reduced the proportion of population required to be reached in order to find half of all expected new infections from 19.4% to 10.6%. FSW were 1.3% of the population but 10.6% of all expected new infections. Our risk group estimates provide data for HIV programmes to set targets and implement differentiated prevention strategies outlined in the Global AIDS Strategy. Successfully implementing this approach would result in more efficiently reaching substantially more of those at risk for infections.

Tobacco, alcohol, cannabis, and illicit drug use and their association with CD4/CD8 cell count ratio in people with controlled HIV: a cross-sectional study (ANRS CO3 AQUIVIH-NA-QuAliV)

BackgroundTo evaluate drug use (alcohol, tobacco, cannabis and other drugs) and its association with mean CD4/CD8 T cell count ratio, a marker of chronic inflammation, in virally suppressed people living with HIV-1 (PLWH) in Nouvelle Aquitaine, France.MethodsA multi-centric, cross-sectional analysis was conducted in 2018–19 in the QuAliV study—ANRS CO3 AQUIVIH-NA cohort. Tobacco, alcohol, cannabis, and other drug use (poppers, cocaine, amphetamines, synthetic cathinones, GHB/GBL) were self-reported. CD4 and CD8 T cell counts and viral load measures, ± 2 years of self-report, and other characteristics were abstracted from medical records. Univariable and multivariable linear regression models, adjusted for age, sex, HIV risk group, time since HIV diagnosis, and other drug use were fit for each drug and most recent CD4/CD8 ratio.Results660 PLWH, aged 54.7 ± 11.2, were included. 47.7% [315/660] had a CD4/CD8 ratio of < 1. Their mean CD4/CD8 ratio was 1.1 ± 0.6. 35% smoked; ~ 40% were considered to be hazardous drinkers or have alcohol use disorder; 19.9% used cannabis and 11.9% other drugs. Chemsex-associated drug users’ CD4/CD8 ratio was on average 0.226 (95% confidence interval [95% CI] − 0.383, − 0.070) lower than that of non-users in univariable analysis (p = 0.005) and 0.165 lower [95% CI − 0.343, 0.012] in multivariable analysis (p = 0.068).ConclusionsMean differences in CD4/CD8 ratio were not significantly different in tobacco, alcohol and cannabis users compared to non-users. However, Chemsex-associated drug users may represent a population at risk of chronic inflammation, the specific determinants of which merit further investigation.Trial registration number: NCT03296202.

GAMBARANPENGETAHUAN DAN SIKAP REMAJA TENTANG HIV/AIDS DI PONDOK PESANTREN ASSULAMI LOMBOK BARAT

HIV stands for Human Immuno deficiency Virus, which is a virus that can weaken immunity on humans. Meanwhile, AIDS stands for Acquired Immune Deficiency Syndrome, which is a collection of symptoms and infections or commonly called syndromes caused by damage to the human immune system due to the HIV virus. HIV / AIDS is a sexually transmitted disease that can causes of death. Adolescents are risk group for HIV / AIDS transmission. Proper knowledge on disease will help them to take prevention efforts. Adolescents promiscuity is a indicator that can transmit the disease. The aim of this research was to identify an overview of adolescent knowledge on HIV / AIDS. The research method used in this research was descriptive research. The populations of this research were 134 students, samples of the research were 57 people. The sampling technique used in this research was random sampling, Instrument of data collection used in this research was questionnaire. This research conducted at Assulamy Langko Islamic Boarding School, West Lombok. The results of this research obtained that more than 30 respondents were female (53%) and 27 respondents (42%) were male. The knowledge of students on HIV / AIDS was 44 respondents (77%) with sufficient criteria, and 13 respondents (23%) were lacking. It can be concluded that the knowledge of adolescents on HIV / AIDS in Assulamy Langko Islamic Boarding School is sufficient. Adolescents have good enough knowledge, but it needs to be considered and improved through providing health education related to HIV / AIDS

Sağlık Çalışanlarında Hepatit A, Hepatit B, Hepatit C ve HIV Seroprevalansı

Amaç: Hepatit A, hepatit B, hepatit C ve HIV kan ve vücut sıvılarının bulaşı açısından önde gelen hastalıklardır. Bu çalışmada, sağlık çalışanlarında HAV, HBV, HCV ve HIV seropozitifliğinin araştırılması amaçlanmıştır.Materyal ve Metot: Sağlık çalışanlarının serum örneklerinde HBsAg, anti-HBs, anti-HCV, anti-HAV IgG, anti-HBc IgG ve anti-HIV testleri kemilüminesans esasına dayanan ELISA yöntemi ile çalışıldı.Bulgular: Çalışmaya dahil edilen 647 sağlık çalışanından 391’i erkek (%60,43) ve 256’sı kadındı (%39,57). Çalışanların 201’i (%31,1) hemşire, 92’si (%14,2) doktor, 94’ü (%14,5) temizlik görevlisi ve 260’ı (%40,2) diğer sağlık personeli idi. HBsAg pozitifliği 12 kişide (%1,8) saptandı. Anti-HBs pozitifliği 561 kişide (%86,7) tespit edildi. Anti-HCV ve anti-HIV pozitifliği herhangi bir sağlık çalışanında saptanmadı. Anti-HAV IgG bakılan 552 kişiden 499 kişide test sonucu pozitif (%90,3), 53 kişide ise negatif (%9,7) olarak sonuçlandı.Sonuç: Sağlık çalışanları HAV, HBV, HCV ve HIV açısından yüksek risk grubunda bulundukları için dönemsel olarak bu virüsler açısından tarama yapılması ve HAV ile HBV’ye karşı bağışık olmayanların aşılanmaları gerekmektedir.

Progress in the quality of care for newly diagnosed people with HIV in Spain (2004-2019).

We monitored the quality of care for newly diagnosed people with HIV (PWH) in Spain, including linkage to care within 1month of HIV diagnosis (LC-1Mo) and viral suppression within 3months of HIV diagnosis (VS-3Mo). Longitudinal study based on The Cohort of the Spanish AIDS Research Network (CoRIS). We used logistic regression stratified by year of HIV diagnosis (2004-2013 and 2014-2019) to assess differences by sex, country of origin, HIV risk group, age, prior AIDS, HIV Viral Load, and CD4 cell count. The final analysis included 13,632 PWH: males 85%, men having sex with men (MSM) 61%, median age 35years. LC-1Mo increased from 42% (95% CI, 38%-46%) in 2004 to 80% (95% CI, 77%-83%) in 2019 (P < 0.001). Median CD4+ cell counts at ART initiation increased from <250/mm3 in 2004-2005 to >350/mm3 since 2012 (P < 0.001). The percentage of initial regimens based on integrase strand transfer inhibitors (INSTI) increased from 3% in 2004 to >70% from 2016 onwards (P < 0.001). VS-3Mo increased from 6% (95% CI, 4%-8%) in 2004 to 45% (95% CI, 41%-49%) in 2019 (P < 0.001). Worst results for LC-1Mo were found among PWH acquiring HIV by injection drug use and those born in Latin American Countries across all the study period. Care indicators have improved among newly diagnosed PWH in Spain over the last 15years. Removal of CD4 cell counts limitations, and probably the increasing use of INSTI-based regimens was decisive for the progress made.

Acceptability and feasibility of HIV self-testing among transgender people in Larkana, Pakistan: Results from a pilot project.

HIV self-testing (HIVST) is an innovative HIV testing approach that effectively reaches those who do not otherwise test, including key populations (KPs). Despite potential benefits, HIVST is not currently implemented in Pakistan. The high risk of HIV among transgender (TGs) persons is among the highest risk group for HIV in Pakistan, yet knowledge of HIV status remains low in this key population group. We conducted a pilot project to assess the acceptability and feasibility of distributing HIVST to TGs in Larkana. Eligible participants were 18 years or above and self-identified as transgender ("hijra"). One oral fluid HIVST kit per person was distributed free of cost in the community by trained transgender peer outreach workers (ORW). Participants could request a demonstration of the HIVST procedure before performing self-testing which was provided by the trained ORW. Demographic characteristics of participants were collected. The ORW followed up with phone calls two days later to record if HIVST kits were used, the results, and whether assistance was required. Between November 2020 and February 2021, 150 HIVST kits were distributed to eligible TGs. The average age of participants was 25.5 years (standard deviation: 7.0). Over a third (52, 34.7%) had no formal education, while (16, 10.6%) had attended at least five years of schooling. Over one-third (58, 38.6%) of participants were first-time testers. One hundred and thirty-nine (92.7%) participants reported their results within two days. For the remaining 11 participants, ORWs had to contact them. All participants reported using HIVST kits within three days. A majority (141, 94%) used the kit in their homes, and the remaining nine (6%) used it at the community-based organization's office. Overall, a small proportion (11, 7.3%) of participants requested a demonstration of the test procedure before performing HIVST. Four (2.7%) participants who had performed unsupervised self-tests reported reactive HIVST results; all were linked to treatment within five working days once their HIV result was confirmed. The majority (136, 90.6%) of participants felt that self-testing was easy to perform independently, and 143 (95%) reported that they would recommend HIVST to their peers. HIVST is acceptable among TGs and identified by first-time testers as undiagnosed infections. Peer-led distribution appears to be a feasible approach for implementation in this setting. HIVST should be considered for routine implementation and scale up to reduce testing gaps among Pakistan's key population, particularly TGs.

Human Immunodeficiency Virus transmission by HIV Risk Group and Along the HIV Care Continuum: A Contrast of 6 US Cities.

Understanding the sources of HIV transmission provides a basis for prioritizing HIV prevention resources in specific geographic regions and populations. This study estimated the number, proportion, and rate of HIV transmissions attributable to individuals along the HIV care continuum within different HIV transmission risk groups in 6 US cities. We used a dynamic, compartmental HIV transmission model that draws on racial behavior-specific or ethnic behavior-specific and risk behavior-specific linkage to HIV care and use of HIV prevention services from local, state, and national surveillance sources. We estimated the rate and number of HIV transmissions attributable to individuals in the stage of acute undiagnosed HIV, nonacute undiagnosed HIV, HIV diagnosed but antiretroviral therapy (ART) naïve, off ART, and on ART, stratified by HIV transmission group for the 2019 calendar year. Individuals with undiagnosed nonacute HIV infection accounted for the highest proportion of total transmissions in every city, ranging from 36.8% (26.7%-44.9%) in New York City to 64.9% (47.0%-71.6%) in Baltimore. Individuals who had discontinued ART contributed to the second highest percentage of total infections in 4 of 6 cities. Individuals with acute HIV had the highest transmission rate per 100 person-years, ranging from 76.4 (58.9-135.9) in Miami to 160.2 (85.7-302.8) in Baltimore. These findings underline the importance of both early diagnosis and improved ART retention for ending the HIV epidemic in the United States. Differences in the sources of transmission across cities indicate that localized priority setting to effectively address diverse microepidemics at different stages of epidemic control is necessary.

Knowledge Regarding HIV/AIDS among Nepalese Army

Introduction: A global pandemic threat HIV/AIDS is also matter of concern of developing countries like Nepal where the first case was identified in July 1988 and later became epidemic and then concentrated epidemic among risk group for HIV. Several studies reflected HIV is associated to many factors, Literacy and Socio-economic conditions being at the highest rank. Members of Nepal army are generally with less educational background and few with higher educational status are at higher post. Thus knowledge regarding HIV/AIDS among this group need to be assessed.&#x0D; Aims: The overall objective of our study was to assess knowledge regarding HIV/AIDS among Nepal army in Banke district.&#x0D; Methods: A Cross-sectional descriptive study with population size of 146 Army was performed which covered the entire population of Shree Shreemehar Army Camp in Banke, starting from 18th June to 27th August, 2018. A pre-tested questionnaire containing structural, semi-structural and open ended questions were made as data collection tool. All the soldiers in Army camp were interviewed after receiving consent as an ethical clearance.&#x0D; Results: All 146 Army of our study were aware about HIV/AIDS mainly via mass media (83.56%). 33 respondents still didn’t know about availability of its treatment. Misconception about its complete cure and vaccination was seen in 12 and 39 respondents respectively. 58 respondents were found knowing about the free health services by government. 141 respondents knew certain things about prevention. 28 respondents admitted of having multiple sex partners and only 24 among them used preventive measure.&#x0D; Conclusion: Though all the respondents of our study had known about HIV/AIDS still they had misconception regarding its treatment and prevention. Many respondents do not even know about the free health services of government. Few of them still don’t use preventive measure.

Pre-Exposure Prophylaxis Perspectives, Sociodemographic Characteristics, and HIV Risk Profiles of Cisgender Women Seeking and Initiating PrEP in a US Demonstration Project.

Little information is known about the cisgender women who seek and initiate pre-exposure prophylaxis (PrEP) for HIV prevention in the United States. Adherence Enhancement Guided by Individualized Texting and Drug Levels was a 48-week single-arm open-label demonstration study of daily oral tenofovir disoproxil fumaratel emtricitabine (TDF/FTC) in cisgender women ≥ 18 years old at risk for HIV. Participants were surveyed at screening and enrollment about sociodemographics, HIV risk perception and behaviors, and PrEP perspectives and aggregated into three risk groups according to HIV sexual risk behavior: being in a serodiscordant partnership (SD), engaging in sex work (SW), and having partners with unknown HIV status at risk for HIV (UP). One hundred sixty-seven women presented for screening with n = 31 screen failures. Of the 162 women completing enrollment, mean age was 40 (standard deviation 11), with 41% non-Hispanic Black, 22% non-Hispanic White, and 19% Latina. Compared with those who screened ineligible, enrolled participants were more likely to have heard of PrEP, had higher HIV risk perception, and reported higher perceived PrEP efficacy. Sixty-four women (47%) were categorized as SD, 21 (15%) as SW, and 51 (38%) as UP. The SW were more likely to report higher levels of drinking and drug use (p = 0.002) and history of intimate partner violence in the past year (p < 0.001) compared with SD and UP. Among cisgender women enrolled, there were significant differences between the three risk groups by demographics, HIV risk behavior, and PrEP perspectives, suggesting that interventions to successfully implement PrEP in US women may need to be tailored by HIV risk group. Clinical Trial Registration number: NCT02584140.

Dramatic decline in new HIV diagnoses in persons born in France in a large nationwide HIV cohort

ObjectivesAs trends in new HIV diagnoses represent a measure of the HIV epidemic, we conducted a 6-year longitudinal study to evaluate the change in rates of new HIV diagnosis, stratified by birthplace, HIV risk groups and CD4 cell count at diagnosis in a large French multicentre cohort. Study designWe performed a retrospective cohort study using data from the mainland French Dat’AIDS cohort. MethodsData were obtained for subjects with a new HIV diagnosis date between 2013 and 2018. HIV diagnosis date was defined as the date of the first known positive HIV serology. ResultsBetween 2013 and 2018, a total of 68,376 people living with HIV (PLHIV) were followed in the Dat’AIDS cohort; 9543 persons were newly diagnosed with HIV. The annual number of new HIV diagnoses decreased from 1856 in 2013, to 1149 in 2018 (−38.1%), P = 0.01; it was more pronounced among subjects born in France, from 858 to 484 (−43.6%), P < 0.01, than in those born abroad (−23.8%, from 821 to 626, P = 0.13). Among subjects born in France, the decrease over the period was −46.7% among men who have sex with men (MSM), −43.5% for heterosexual women and −33.3% for heterosexual men. ConclusionOur findings show changes in HIV epidemiology in PLHIV born in France, with a decline around 40% in new HIV diagnoses, and a more pronounced decrease among MSM and heterosexual women. Our results support the long-term effectiveness of the antiretroviral therapy as a prevention strategy among the various tools for HIV prevention.

Estimating the prevalence of and characteristics associated with prescription opioid diversion among a clinic population living with HIV: Indirect and direct questioning techniques

BackgroundEvidence suggests that over 50 % of individuals who used prescription opioids non-medically obtained their prescription from friends or family. Despite its high consequence, reliable opioid diversion prevalence estimates are lacking due to social desirability bias. We used indirect questioning, a technique designed to measure sensitive behaviors, to assess the prevalence of prescription opioid diversion among a cohort of individuals with HIV. MethodsWe randomized 581 participants from a large urban HIV clinical cohort to answer either a direct or indirect question about opioid diversion between October 2016-July 2018. We estimated the prevalence of diversion under each method. We also estimated diversion prevalence in subsets of the sample by age, sex, race, HIV risk group, substance use, and mental health co-morbidities. ResultsOf 1,285 patients screened, 581 (45.2 %) reported ever having received an opioid prescription. Of these, 252 (43.4 %) directly answered whether they had ever diverted opioids and 313 (53.9 %) answered the indirect question. The prevalence of opioid diversion under direct and indirect questioning was 6.3 % (95 % CI 3.7 %–10.1 %) and 15.3 % (95 % CI 10.4 %–20.3 %), respectively. In unadjusted analyses, males, non-African Americans, and patients with a history of illicit drug use had a higher diversion prevalence. In adjusted analyses, ever having used cocaine was most associated with diversion (OR 15.67, 95 % CI 0.93−263.17). ConclusionsOpioid diversion was common among this population, with the estimated prevalence more than doubling under the indirect questioning method designed to elicit less biased responses.

Nurses Role in Prevention of HIV/AIDS

Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition as per World Health Organization there are about 37.9 Million peoples living with AIDS/HIV in the world and out of which only 23.3 Million peoples accessing antiretroviral therapy but remaining are still not under treatment and such peoples may spread/transmit HIV more and rapid. Awareness is required among peoples living with HIV and high risk groups should consider on high priority. Nurses play key role in prevention of HIV/AIDS by significant functions such as health education to youths, high risk groups and eligible couples and prophylaxis. There is no treatment or vaccine not available to cure this syndrome, so for this deadly syndrome prevention is much better than cure is possible.

DBP rs16846876 and rs12512631 polymorphisms are associated with progression to AIDS na\xefve HIV-infected patients: a retrospective study

BackgroundMost of the circulating Vitamin D (VitD) is transported bound to vitamin D-binding protein (DBP), and several DBP single nucleotide polymorphisms (SNPs) have been related to circulating VitD concentration and disease. In this study, we evaluated the association among DBP SNPs and AIDS progression in antiretroviral treatment (ART)-naïve-HIV-infected patients.MethodsWe performed a retrospective study in 667 patients who were classified according to their pattern of AIDS progression (183 long-term non-progressors (LTNPs), 334 moderate progressors (MPs), and 150 rapid progressors (RPs)) and 113 healthy blood donors (HIV, HCV, and HBV negative subjects). We genotyped seven DBP SNPs (rs16846876, rs12512631, rs2070741, rs2282679, rs7041, rs1155563, rs2298849) using Agena Bioscience’s MassARRAY platform. The genetic association was evaluated by Generalized Linear Models adjusted by age at the moment of HIV diagnosis, gender, risk group, and VDR rs2228570 SNP. Multiple testing correction was performed by the false discovery rate (Benjamini and Hochberg procedure; q-value).ResultsAll SNPs were in HWE (p > 0.05) and had similar genotypic frequencies for DBP SNPs in healthy-controls and HIV-infected patients. In unadjusted GLMs, we only found significant association with AIDS progression in rs16846876 and rs12512631 SNPs. In adjusted GLMs, DBP rs16846876 SNP showed significant association under the recessive inheritance model [LTNPs vs. RPs (adjusted odds ratio (aOR) = 3.53; q-value = 0.044) and LTNPs vs. MPs (aOR = 3.28; q-value = 0.030)] and codominant [LTNPs vs. RPs (aOR = 4.92; q-value = 0.030) and LTNPs vs. MPs (aOR = 3.15; q-value = 0.030)]. Also, we found DBP rs12512631 SNP showed significant association in the inheritance model dominant [LTNPs vs. RPs (aOR = 0.49; q-value = 0.031) and LTNPs vs. MPs (aOR = 0.6; q-value = 0.047)], additive [LTNPs vs. RPs (aOR = 0.61; q-value = 0.031)], overdominant [LTNPs vs. MPs (aOR = 0.55; q-value = 0.032)], and codominant [LTNPs vs. RPs (aOR = 0.52; q-value = 0.036) and LTNPs vs. MPs (aOR = 0.55; q-value = 0.032)]. Additionally, we found a significant association between DBP haplotypes (composed by rs16846876 and rs12512631) and AIDS progression (LTNPs vs RPs): DBP haplotype AC (aOR = 0.63; q-value = 0.028) and the DBP haplotype TT (aOR = 1.64; q-value = 0.028).ConclusionsDBP rs16846876 and rs12512631 SNPs are related to the patterns of clinical AIDS progression (LTNP, MP, and RP) in ART-naïve HIV-infected patients. Our findings provide new knowledge about AIDS progression that may be relevant to understanding the pathogenesis of HIV infection.

1630. Voluntary HIV Testing and Self-Realization of Risk of HIV Infection Among Young Men-Who-Have-Sex-with-Men in the Miami-Dade Area

BackgroundAccording to the Centers for Disease Control and Prevention, Miami-Dade County has the highest rate of new HIV diagnoses in the Nation. So far, a large focus of public health initiatives has been spreading awareness of HIV testing locations, but this form of voluntary testing relies on individuals realizing that they are at risk of HIV infection in the first place. Consequently, a major obstacle to encouraging young men-who-have-sex-with-men (YMSM) to test themselves for HIV is their own self-perceived risk of having an undetected infection.MethodsIn an effort to better understand the discordance between high-risk sexual behavior and HIV testing among this high-risk population, YMSM (18–24) were surveyed through smartphone applications that facilitate sexual encounters in the Miami-Dade area (eg Grindr, Scruff). Users were asked about their history of condomless anal intercourse (CAI), their HIV testing habits, and whether or not they believe it possible that they are currently infected with HIV. An analysis of the relationship between CAI and self-perception of possible HIV infection was performed using Cochran-Mantel–Haenszel testing.ResultsOf the 843 eligible responses, 667 reported a history of voluntary HIV testing while 176 had never voluntarily tested. 726 respondents reported a history of CAI and 131 of these have never voluntarily tested. Of the 843 total participants, 1.6% were in the highest HIV risk group, which is those who have engaged in CAI with an exchange/casual partner, have never voluntarily tested for HIV, and have no self-perceived risk of being currently infected. According to data analysis, YMSM who have engaged in CAI but have never been tested for HIV were not more likely to have a self-perceived possibility of infection when compared with those who have voluntarily tested (P < 0.595).ConclusionThis suggests that many high-risk YMSM are not voluntarily testing themselves for HIV not because they do not have access to testing, but rather because they do not perceive themselves as being possibly infected in the first place. Therefore, in addition to increasing access to HIV testing, new public health initiatives must be designed to facilitate YMSM understanding their own personal HIV risk.Disclosures All authors: No reported disclosures.

Characteristics of recently arrived Asian men who have sex with men diagnosed with HIV through sexual health services in Melbourne and Sydney

Objectives:Asian men who have sex with men (MSM) who have recently arrived in Australia are an emergent risk group for HIV; however, little is known about how they compare to Australian MSM diagnosed with HIV. This study compared the characteristics of these two groups. Methods:A retrospective, cross‐sectional study of MSM diagnosed with HIV between January 2014 and October 2017 in Melbourne and Sydney public sexual health clinics. Asian MSM were those who had arrived in Australia within 4 years of diagnosis. Results:Among 111 Asian men, 75% spoke a language other than English, 88% did not have Medicare and 61% were international students. Compared with Australian men (n=209), Asian men reported fewer male sexual partners within 12 months (median 4 versus 10, p<0.001), were less likely to have tested for HIV previously (71% versus 89%, p<0.001) and had a lower median CD4 count (326 versus 520, p<0.001). Among Asian men, HIV subtype CRF01‐AE was more common (55% versus 16%, p<0.001) and subtype B less common (29% versus 73%, p<0.001). Conclusions:Asian MSM diagnosed with HIV reported lower risk and had more advanced HIV. Implications for public health:HIV testing and preventative interventions supporting international students are required.

El papel de las intervenciones biomédicas en la prevención del VIH: la profilaxis preexposición (PrEP)

HIV infection remains an important public health problem worldwide. The traditional preventive measures, such as sexual education, screening, and early antiretroviral treatment initiation, despite having shown their effectiveness, are not enough to control new infections. In this context, Pre-Exposure Prophylaxis (PrEP) has been investigated as a preventive measure. Currently, it has been extensively documented that the administration of antiretroviral treatment in an HIV exposed, but not infected population, could reduce the risk of transmission without significant drawbacks. Despite its high efficacy for HIV prevention, the use of PrEP remains a controversial measure, particularly its cost-effectiveness. For this reason, the access to PrEP is not available for all the HIV risk groups. Therefore, and based on the evidence found, the current approach must be the repercussions of not to implement PrEP, more than its cost or its effectiveness.

Combined estimation of disease progression and retention on antiretroviral therapy among treated individuals with HIV in the USA: a modelling study

Accurately estimating HIV disease progression and retention on antiretroviral therapy (ART) can help inform interventions to control HIV microepidemics and mathematical models used to inform health-resource allocation decisions. Our objective was to estimate the monthly probabilities of on-ART CD4 T-cell count progression, mortality, ART dropout, and ART reinitiation using a continuous-time multistate Markov model. We also aimed to validate health-state transition probability estimates to ensure they accurately reproduced the regional HIV microepidemics across the USA. In our modelling study, we considered a cohort of patients from the HIV Research Network, a consortium of 17 adult and paediatric HIV-care providers located in the northeastern (n=8), southern (n=5), and western (n=4) regions of the USA. Individuals aged 15 years or older who were in HIV care (defined as one CD4 test and one HIV-care visit in a calendar year period) with at least one ART prescription between Jan 1, 2010, and Dec 31, 2015, were included in the analysis. We used continuous-time multistate Markov models to estimate transitions between CD4 strata and between on-ART and off-ART states. We examined and adjusted for differences in probability of transition by region, race or ethnicity, sex, HIV risk group, and other baseline clinical indicators. The median age of the 32 242 individuals included in the analysis was 44 years (interquartile range 35-51). Over a median follow-up of 4·9 years (2·6-6·0), 8614 (26·7%) of 32 242 people interrupted ART and 1325 (4·1%) of 32 242 people died. Women, men who have sex with men, and individuals with no previous ART experience had greater increases in CD4 cell counts, whereas black people and people who inject drugs had increased probabilities of ART dropout and faster disease progression. Regardless of CD4 strata, individuals had increased hazard for ART dropout if they were from the south (adjusted hazard ratio [aHR] range from 1·91, 95% CI 1·71-2·13, to 2·45, 2·29-2·62) or the west (aHR range from 1·29, 1·10-1·51, to 1·66, 1·51-1·82) of the USA, compared with individuals from the northeast USA. Our results show heterogeneities in disease progression during ART and probability of ART retention across race and ethnicity, HIV risk groups, and regions. These differences should be viewed as targets for intervention and should be incorporated in mathematical models of regional HIV microepidemics in the USA. US National Institutes of Health, Agency for Healthcare Research and Quality, and Health Resources and Services Administration.

Prevalence of anti-hepatitis E virus immunoglobulin G in HIV-infected individuals over three decades

BackgroundHepatitis E virus (HEV) genotype 3 is endemic in Europe, and the infection is mostly subclinical or acute and self-limiting. However, persistent infection is described among HIV-infected individuals. The prevalence of antibodies against HEV (anti-HEV) among HIV-infected persons varies geographically and is unknown in Denmark. Rates of co-infection with HEV among HIV-infected individuals in Denmark over three decades, from the early 1980s to 2013, were investigated. MethodsA total of 2506 HIV-infected persons were investigated from two cohorts followed at Hvidovre Hospital, Denmark. Blood samples were tested retrospectively for anti-HEV, including samples from 2216 persons who were enrolled in a prospective clinical cohort and followed between 1995 and 2013, as well as samples from 290 persons from a historical cohort followed between 1980 and 1994. For anti-HEV seroconverting individuals, serial samples were tested for HEV RNA. Factors associated with anti-HEV status were explored using multivariable logistic regression analysis. ResultsThe overall HEV seroprevalence rates were stable during the 1980s, 1990s, and 2000–2013 (23.1%, 22.9%, and 23.7%, respectively). In all decades, rates of anti-HEV increased with older age, and anti-HEV seropositivity was associated with older generations, HIV risk group, and geographic origin. Persistent HEV infection was not detected in any of 57 individuals with anti-HEV seroconversion. ConclusionsHEV seroprevalence rates were stable in HIV-infected individuals from the early 1980s to 2013. Rates increased with age. No evidence of persistent HEV infection was detected. Infection with HEV is frequent, but persistent HEV infection is rare among HIV-infected individuals.